Tada Toshifumi, Toyoda Hidenori, Yasuda Satoshi, Kumada Takashi, Kurisu Akemi, Ohisa Masayuki, Akita Tomoyuki, Tanaka Junko
Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.
Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan.
Hepatol Res. 2020 Aug;50(8):936-946. doi: 10.1111/hepr.13512. Epub 2020 Jun 25.
The long-term prognosis of patients with chronic hepatitis C virus (HCV) infection who have received antiviral therapy and who demonstrate HCV eradication remains incompletely characterized. In this study, we investigated the long-term prognosis of liver disease in patients with eradication of HCV.
A total of 552 patients with chronic HCV infection (6815 person-years) who were treated with interferon-based therapy and who achieved sustained virologic response were included. Yearly transition probabilities for each liver state (chronic hepatitis, cirrhosis, and hepatocellular carcinoma [HCC]) were calculated using a Markov chain model.
In the analysis of 1-year liver disease state transition probabilities, progression to cirrhosis occurred in 0.5-2.1% of male patients with chronic hepatitis across all age groups. In male patients with cirrhosis, HCC developed in 0.6-1.9% of patients over the age of 50 years. In female patients with chronic hepatitis, progression to cirrhosis occurred in 0.4-2.1% of patients across all age groups. In addition, in female patients with cirrhosis, HCC developed in those aged 60-69 (0.4%) and 70-79 (0.4%) years. Under the assumption of either a chronic hepatitis or cirrhosis state at age 40 or 60 years as the starting condition for simulation over the next 40 or 20 years, respectively, the probability of HCC gradually increased with age and was higher in male patients.
The development or progression of cirrhosis and the development of HCC are risks in HCV patients despite HCV eradication, not only in those with cirrhosis but also in those with chronic hepatitis.
接受抗病毒治疗且已实现丙型肝炎病毒（HCV）清除的慢性丙型肝炎病毒感染患者的长期预后仍未完全明确。在本研究中，我们调查了HCV清除患者肝脏疾病的长期预后。
纳入了总共552例接受基于干扰素治疗并实现持续病毒学应答的慢性HCV感染患者（6815人年）。使用马尔可夫链模型计算每个肝脏状态（慢性肝炎、肝硬化和肝细胞癌[HCC]）的年度转移概率。
在对1年肝脏疾病状态转移概率的分析中，所有年龄组的慢性肝炎男性患者中，进展为肝硬化的比例为0.5%-2.1%。在50岁以上的肝硬化男性患者中，HCC发生率为0.6%-1.9%。在所有年龄组的慢性肝炎女性患者中，进展为肝硬化的比例为0.4%-2.1%。此外，在60-69岁（0.4%）和70-79岁（0.4%）的肝硬化女性患者中发生了HCC。分别以40岁或60岁时的慢性肝炎或肝硬化状态作为接下来40年或20年模拟的起始条件，HCC的发生概率随年龄逐渐增加，且男性患者更高。
肝硬化的发生或进展以及HCC的发生是HCV患者的风险，即使HCV已清除，不仅在肝硬化患者中如此，在慢性肝炎患者中也是如此。
