病毒清除可降低接受直接抗病毒治疗的慢性丙型肝炎病毒感染患者的全因死亡率。

Viral eradication reduces all-cause mortality in patients with chronic hepatitis C virus infection who had received direct-acting antiviral therapy.

机构信息

Department of Gastroenterology, Japanese Red Cross Society Himeji Hospital, Himeji, Japan.

Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.

出版信息

Liver Int. 2024 Nov;44(11):3060-3071. doi: 10.1111/liv.16093. Epub 2024 Sep 2.

DOI:10.1111/liv.16093

PMID:39223936

Abstract

BACKGROUND AND AIMS

The impact of hepatitis C virus (HCV) eradication via direct-acting antiviral (DAA) therapy on overall mortality, particularly non-liver-related mortality, is understudied.

METHODS

We recruited 4180 patients with chronic HCV infection who achieved sustained virological response (SVR) (HCV eradication) through DAA therapy (n = 2501, SVR group) or who did not receive antiviral therapy (n = 1679, non-SVR group); 1236 from each group were chosen using propensity score matching. Causes of death and all-cause mortality, including non-liver-related diseases, were investigated.

RESULTS

Of the 4180 patients, 592 died during the follow-up period. In the SVR group, the mortality rates from liver-related and non-liver-related diseases were 16.5% and 83.5%, respectively. Compared to the non-SVR group, mortality rates from liver-related and non-liver-related diseases were 50.1% and 49.9%, respectively (p < .001). In non-cirrhotic patients, multivariable analysis revealed that SVR was an independent factor associated with both liver-related (hazard ratio [HR], .251; 95% confidence interval [CI], .092-.686) and non-liver-related (HR, .641; 95% CI, .415-.990) mortalities. In cirrhotic patients, multivariable analysis revealed that SVR remained an independent factor significantly associated with liver-related mortality (HR, .151; 95% CI, .081-.279). In propensity score-matched patients, the eradication of HCV (SVR group) decreased both liver-related (p < .001) and non-liver-related mortality (p = .008) rates compared to persistent HCV infection (non-SVR group).

CONCLUSIONS

The elimination of HCV via DAA therapy reduced not only liver-related mortality but also non-liver-related mortality in patients with chronic HCV.

摘要

背景和目的

通过直接作用抗病毒药物（DAA）治疗清除丙型肝炎病毒（HCV）对全因死亡率的影响，特别是非肝脏相关死亡率的影响，研究甚少。

方法

我们招募了 4180 例通过 DAA 治疗实现持续病毒学应答（SVR）（HCV 清除）的慢性 HCV 感染患者（n=2501，SVR 组）或未接受抗病毒治疗的患者（n=1679，非 SVR 组）；每组使用倾向评分匹配选择 1236 例患者。研究了死亡原因和全因死亡率，包括非肝脏相关疾病。

结果

在 4180 例患者中，有 592 例在随访期间死亡。在 SVR 组中，肝脏相关和非肝脏相关疾病的死亡率分别为 16.5%和 83.5%。与非 SVR 组相比，肝脏相关和非肝脏相关疾病的死亡率分别为 50.1%和 49.9%（p<.001）。在非肝硬化患者中，多变量分析显示 SVR 是与肝脏相关（危险比 [HR]，0.251；95%置信区间 [CI]，0.092-0.686）和非肝脏相关（HR，0.641；95%CI，0.415-0.990）死亡相关的独立因素。在肝硬化患者中，多变量分析显示 SVR 仍然是与肝脏相关死亡率显著相关的独立因素（HR，0.151；95%CI，0.081-0.279）。在倾向评分匹配的患者中，与持续 HCV 感染（非 SVR 组）相比，通过 DAA 治疗清除 HCV（SVR 组）降低了肝脏相关（p<.001）和非肝脏相关死亡率（p=0.008）。