Niederau C, Lange S, Heintges T, Erhardt A, Buschkamp M, Hürter D, Nawrocki M, Kruska L, Hensel F, Petry W, Häussinger D
Department of Medicine, Division of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany.
Hepatology. 1998 Dec;28(6):1687-95. doi: 10.1002/hep.510280632.
The prognosis of chronic hepatitis C virus (HCV) infection is still ill-defined. The present study prospectively evaluated mortality and complications in a large cohort of patients with chronic hepatitis C. The study included 838 anti-HCV and HCV-RNA-positive patients who were followed for 50.2 +/- 26.9 months (mean +/- SD; range, 6-122 months) in a prospective protocol. During follow-up, 62 patients died (31 from liver disease and 31 from other causes), and 12 patients needed liver transplantation. When compared with a matched general population, hepatitis C increased mortality mainly when cirrhosis was present and in patients who were less than 50 years old at study entry. During follow-up, a further 30 patients developed nonlethal complications of cirrhosis. By multivariate regression, survival was decreased by cirrhosis, long disease duration, history of intravenous drug abuse, and excessive alcohol consumption, whereas interferon therapy improved survival. Alanine transaminase (ALT), bilirubin, sex, and genotype had no effect on survival. The risk of hepatocellular carcinoma (HCC) (n = 17) was increased by cirrhosis and to a lesser degree by long disease duration and high bilirubin, whereas interferon therapy, genotype, and other factors had no effect. Chronic hepatitis C is a disease with considerable mortality and morbidity when cirrhosis is present at diagnosis. Patients who acquire the infection early in life have a markedly increased mortality even when cirrhosis is absent at diagnosis. The age at diagnosis therefore should play a major role in therapeutic considerations. The present data also suggest that interferon therapy has a long-term clinical benefit, although it did not reduce the risk of liver cancer.
慢性丙型肝炎病毒（HCV）感染的预后仍不明确。本研究对一大群慢性丙型肝炎患者的死亡率和并发症进行了前瞻性评估。该研究纳入了838例抗-HCV和HCV-RNA阳性患者，按照前瞻性方案对其进行了50.2±26.9个月（平均±标准差；范围为6-122个月）的随访。随访期间，62例患者死亡（31例死于肝脏疾病，31例死于其他原因），12例患者需要进行肝移植。与匹配的普通人群相比，丙型肝炎主要在存在肝硬化以及研究入组时年龄小于50岁的患者中增加死亡率。随访期间，另有30例患者出现了非致命性肝硬化并发症。通过多因素回归分析，肝硬化、病程长、静脉药物滥用史和过度饮酒会降低生存率，而干扰素治疗可提高生存率。丙氨酸转氨酶（ALT）、胆红素、性别和基因型对生存率无影响。肝硬化会增加肝细胞癌（HCC）（n = 17）的风险，病程长和高胆红素在较小程度上也会增加该风险，而干扰素治疗、基因型和其他因素则无影响。当诊断时存在肝硬化时，慢性丙型肝炎是一种具有相当高死亡率和发病率的疾病。即使诊断时不存在肝硬化，早年感染该病毒的患者死亡率也会显著增加。因此，诊断时的年龄在治疗考量中应起主要作用。目前的数据还表明，干扰素治疗具有长期临床益处，尽管它并未降低肝癌风险。
