Determinants of outcome of compensated hepatitis C virus-related cirrhosis
Determinants of outcome of compensated hepatitis C virus-related cirrhosis
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DOI：
10.1002/hep.510270535
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发表时间：
1998-05-01
期刊：
影响因子：
13.5
通讯作者：
Poupon, R
中科院分区：
文献类型：
--
作者：
Serfaty, L;Aumaître, H;Poupon, R
本研究的目的是评估失代偿的发生率（腹水、黄疸、静脉曲张出血和脑病）、肝细胞癌（HCC）和代偿性丙型肝炎病毒（HCV）相关肝硬化患者的死亡或肝移植，考虑到病毒基因型和干扰素（IFN）治疗。668例无失代偿临床证据的患者因抗HCV抗体阳性和转氨酶活性升高而被转诊至我科进行肝活检，其中103例患者有肝硬化。中位随访时间为40个月。59例患者接受IFN治疗，平均持续时间为11 +/- 6个月; 3例（5%）出现长期生化和病毒学应答。IFN治疗和未治疗患者的基线特征无显著差异。HCV基因型（InnoLiPa）以Ib型（48%）和3a型（20%）为主。随访期间，26例患者发生肝硬化并发症，11例患者发生肝癌，19例患者发生与肝癌无关的失代偿。16例患者死亡，94%为肝病。三名患者因肝功能衰竭而接受移植。肝癌的4年风险为11.5%（年发病率为3.3%），失代偿为20%。2年和4年生存率分别为96%和84%。在多变量分析中，没有IFN治疗是HCC和失代偿的唯一独立预测因素。入组时低白蛋白水平和未接受干扰素治疗是预测死亡或肝移植的两个独立因素。IFN治疗组和未治疗组的2年和4年生存率有显著差异（分别为97%和92% vs 95%和63%，P <0.0001）。总之，在代偿性HCV相关肝硬化患者中：1）肝硬化并发症频繁，无论病毒基因型如何; 2）肝硬化的严重程度和IFN治疗的缺乏是不良结局的独立预测因素。
The aim of this study was to assess the incidence of decompensation (ascites, jaundice, variceal bleeding, and encephalopathy), hepatocellular carcinoma (HCC) and death or liver transplantation in patients with compensated hepatitis C virus (HCV)-related cirrhosis, taking into account the viral genotype and interferon (IFN) therapy Between 1989 and 1994, 668 patients with no clinical evidence of decompensation were referred to our department for liver biopsy because of positivity for anti-HCV antibodies and elevated aminotransferase activity; 103 of these patients had cirrhosis. The median follow-up was 40 months. Fifty-nine patients were treated with IFN for a mean duration of 11 +/- 6 months; 3 (5%) had a prolonged biochemical and virological response. Baseline characteristics of IFN-treated and untreated patients were not significantly different. HCV genotypes (InnoLiPa) were predominantly Ib (48%) and 3a (20%), During follow-up, complications of cirrhosis occurred in 26 patients, HCC in 11 patients, and decompensation not related to HCC in 19 patients. Sixteen patients died, 94% of liver disease. Three patients were transplanted for liver failure. The 4-year risk of HCC was 11.5% (annual incidence 3.3%) and that of decompensation was 20%. Survival probability was 96% and 84% at 2 and 4 years, respectively. In multivariate analysis, the absence of IFN therapy was the only independent factor predictive both for HCC and decompensation. A low albumin level at entry and the absence of IFN therapy were the two independent factors predictive of death or liver transplantation. Probability of survival at 2 and 4 years was significantly different between IFN-treated and untreated patients (respectively 97% and 92% vs 95% and 63%, P < .0001). In conclusion, in patients with compensated HCV-related cirrhosis: 1) complications of cirrhosis are frequent, whatever the viral genotype; and 2) the severity of cirrhosis and the absence of IFN therapy are independently predictive of bad outcome.