慢性丙型肝炎严重程度及疾病进展的相关因素。

Factors associated with severity and disease progression in chronic hepatitis C.

作者信息

Tassopoulos N C, Papatheodoridis G V, Katsoulidou A, Delladetsima J K, Sypsa V, Touloumi G, Nikandros M, Hatzakis A

机构信息

First Department of Medicine, Western Attica General Hospital, Athens, Greece.

出版信息

Hepatogastroenterology. 1998 Sep-Oct;45(23):1678-83.

PMID:9840128

Abstract

BACKGROUND/AIMS: Chronic hepatitis C appears to have a highly variable natural course with 20% of patients developing cirrhosis within 20 years, while the majority of them run a relatively mild course. We studied the relationships of epidemiological, biochemical and virological features with histological severity (grade) and liver disease progression (stage).

METHODOLOGY

Liver histology, serum HCV RNA level and HCV genotype were determined in a well-defined cohort of 152 consecutive (100 males, 52 females) patients with chronic hepatitis C.

RESULTS

Patients with minimal or mild chronic hepatitis were significantly younger than those with moderate or severe chronic hepatitis (mean age: 41.1 vs 49.5 years respectively, p=0.003). On the other hand, patients with no or mild fibrosis compared to those with moderate or severe fibrosis and to those with cirrhosis were significantly more frequently males (73%, 64% and 43%, p=0.01), parenteral drug users (36%, 11% and 11%, p=0.01) and infected with other than 1b genotype (86%, 52% and 33%, p<0.0001), significantly younger (mean age: 37, 48 and 58 years, p<0.0001) and had significantly lower HCV RNA levels (geometric mean: 6.9, 19.2 and 17.5 x 10(5) eq/ml, p=0.007). Multivariate analysis showed that stage was significantly related only to patient age (p<0.0001), HCV genotype (p=0.0025) and HCV RNA level (p=0.044).

CONCLUSIONS

In chronic hepatitis C, histological severity seems to be associated only with patient age, while progression of the disease is mainly associated with patient age, HCV genotype and viremia level.

摘要

背景/目的：丙型肝炎的自然病程高度可变，20%的患者在20年内发展为肝硬化，而大多数患者病情相对较轻。我们研究了流行病学、生化和病毒学特征与组织学严重程度（分级）和肝病进展（分期）之间的关系。

方法

对152例连续的（100例男性，52例女性）慢性丙型肝炎患者进行了明确分组，测定其肝脏组织学、血清HCV RNA水平和HCV基因型。

结果

轻度或中度慢性肝炎患者明显比中度或重度慢性肝炎患者年轻（平均年龄分别为41.1岁和49.5岁，p = 0.003）。另一方面，与中度或重度纤维化患者以及肝硬化患者相比，无纤维化或轻度纤维化患者中男性比例显著更高（分别为73%、64%和43%，p = 0.01），静脉注射毒品使用者比例更高（分别为36%、11%和11%，p = 0.01），感染非1b基因型的比例更高（分别为86%、52%和33%，p < 0.0001），年龄明显更小（平均年龄分别为37岁、48岁和58岁，p < 0.0001），HCV RNA水平显著更低（几何平均数分别为6.9、19.2和17.5×10⁵eq/ml，p = 0.007）。多因素分析显示，分期仅与患者年龄（p < 0.0001）、HCV基因型（p = 0.0025）和HCV RNA水平（p = 0.044）显著相关。