Gentilini P, Laffi G, La Villa G, Casini-Raggi V, Romanelli R G, Buzzelli G, Mazzanti R, Marra F, Pinzani M, Zignego A L
Istituto di Medicina Interna, Università degli Studi di Firenze.
Ann Ital Med Int. 1996 Oct;11 Suppl 2:23S-29S.
The role of hepatitis B virus (HBV) and hepatitis C virus (HCV) as a major cause of chronic liver disease is now accepted worldwide. This study was aimed at evaluating the natural history of the disease in patients with virus-induced chronic active hepatitis or cirrhosis, and the influence played by age, sex and etiology, liver function tests and by the occurrence of different complications. We retrospectively examined the clinical records of 506 inpatients: 194 were affected by chronic active hepatitis (125 males, 69 females, mean age 45 +/- 11 years, 146 HCV- and 48 HBV-related), and 312 by cirrhosis without clinical evidence of portal hypertension (178 males, 134 females, mean age 53 +/- 9 years, 249 HCV- and 63 HBV-related). The occurrence of cirrhosis in the chronic active hepatitis group was then calculated, together with the occurrence of complications and the cumulative mortality rate of established cirrhosis. During follow-up 93 patients with chronic hepatitis developed cirrhosis. The cumulative probability of developing cirrhosis in this group was 6.64% at 5 years, 56.1% at 10 years and 86.8% at 15 years. These patients were therefore included in the cirrhosis group for the final analysis, so that a total of 405 cirrhotic patients were evaluated: these patients had a cumulative survival rate of 99.1% at 5, 76.8% at 10 and 49.4% at 15 years. Comparing the age-adjusted death rate of our patients with the general Italian population, we observed that in patients with liver cirrhosis it was 3.14 and 2.84 times higher in men and women, respectively. Bilirubin was an independent indicator of survival. Several complications, such as esophageal varices, ascites, jaundice, hemorrhage, hepatic encephalopathy and hepatocellular carcinoma significantly reduced the survival rate and were indicated as major complications, while thrombocytopenia, cholelithiasis and diabetes did not affect survival and thus were called minor complications. Incidence of hepatocellular carcinoma was very high especially in males, without correlation with etiology. In conclusion, the progression of virus-induced chronic active hepatitis to cirrhosis is not influenced by sex and etiology. Similarly, the different etiology does not modify the natural history of cirrhosis while the occurrence of one or more major complications significantly shortens survival. The longer survival rate observed in patients with cirrhosis included in this study is probably due to the selective inclusion of patients with early disease and no evidence of portal hypertension.
乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）作为慢性肝病的主要病因，目前已被全球公认。本研究旨在评估病毒诱导的慢性活动性肝炎或肝硬化患者的疾病自然史，以及年龄、性别、病因、肝功能检查和不同并发症的发生所产生的影响。我们回顾性检查了506例住院患者的临床记录：194例为慢性活动性肝炎患者（男性125例，女性69例，平均年龄45±11岁，146例与HCV相关，48例与HBV相关），312例为无门静脉高压临床证据的肝硬化患者（男性178例，女性134例，平均年龄53±9岁，249例与HCV相关，63例与HBV相关）。然后计算慢性活动性肝炎组中肝硬化的发生率、并发症的发生率以及已确诊肝硬化的累积死亡率。在随访期间，93例慢性肝炎患者发展为肝硬化。该组发生肝硬化的累积概率在5年时为6.64%，10年时为56.1%，15年时为86.8%。因此，这些患者被纳入肝硬化组进行最终分析，共有405例肝硬化患者接受评估：这些患者在5年时的累积生存率为99.1%，10年时为76.8%，15年时为49.4%。将我们患者的年龄校正死亡率与意大利普通人群进行比较，我们观察到肝硬化患者中男性和女性的年龄校正死亡率分别高出3.14倍和2.84倍。胆红素是生存的独立指标。几种并发症，如食管静脉曲张、腹水、黄疸、出血、肝性脑病和肝细胞癌，显著降低了生存率，被视为主要并发症，而血小板减少症、胆石症和糖尿病不影响生存，因此被称为次要并发症。肝细胞癌的发生率非常高，尤其是在男性中，与病因无关。总之，病毒诱导的慢性活动性肝炎向肝硬化的进展不受性别和病因的影响。同样，不同的病因不会改变肝硬化的自然史，而一种或多种主要并发症的发生会显著缩短生存期。本研究中观察到的肝硬化患者较长的生存率可能是由于选择性纳入了早期疾病且无门静脉高压证据的患者。
