Favorable prognosis of chronic hepatitis C after interferon therapy by long-term cohort study
Favorable prognosis of chronic hepatitis C after interferon therapy by long-term cohort study
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DOI：
10.1053/jhep.2003.50329
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发表时间：
2003-08-01
期刊：
影响因子：
13.5
通讯作者：
Saisho, H
中科院分区：
文献类型：
--
作者：
Imazeki, F;Yokosuka, O;Saisho, H
慢性丙型肝炎患者接受干扰素治疗后的预后仍不明确。本研究评估了IFN治疗对此类患者队列生存率的影响。该研究包括459例经活检证实的C病毒慢性肝病患者，随访时间为8.2 +/- 2.9年（范围，7-183个月）。通过病历或直接问卷调查来检查生存状况。随访期间，104例未接受IFN治疗的患者中有15例（14%）死亡，355例接受IFN治疗的患者中有33例（9%）死亡。在接受治疗的患者中，116例持续病毒学应答的患者中有4例（3%）死亡，239例无持续病毒学应答的患者中有29例（12%）死亡。肝脏相关死亡32例（67%），肝细胞癌（HCC）造成25（52%）的48例死亡。多变量考克斯比例回归分析显示，干扰素治疗使总死亡风险比降至0.521（置信区间[CI]：0.263-1.034），肝脏相关死亡为0.208（CI：0.088-0.495），持续病毒学应答显示总体死亡风险比降低至0.219（CI：0.068-0.710）和肝脏相关死亡为0.030（CI：0.003-0.267）。干扰素治疗与肝脏无关的死亡无关。此外，与未治疗患者相比，IFN治疗患者的所有死因和肝脏相关死亡的标准化死亡率降低（总死亡率为1.4 vs. 2.0，肝脏相关死亡率为7.9 vs. 19.7）。总之，目前的数据表明，干扰素治疗慢性丙型肝炎患者有一个长期的临床效益，减少肝脏相关的死亡，特别是在持续的病毒学应答的患者。
The prognosis of patients with chronic hepatitis C after interferon (IFN) therapy is still poorly defined. The present study evaluated the effect of IFN therapy on survival in a cohort of such patients. The study included 459 patients with biopsy-proven C-viral chronic liver disease who were followed for 8.2 +/- 2.9 years (range, 7-183 months). Survival status was examined by medical records or direct questionnaires. Fifteen (14%) of 104 IFN-untreated patients and 33 (9%) of 355 patients treated with IFN died during follow-up. Among the treated patients, 4 (3%) of 116 with sustained virologic response and 29 (12%) of 239 without sustained virologic response died. Liver-related death was shown in 32 (67%) patients, and hepatocellular carcinoma (HCC) caused 25 (52%) of the 48 deaths. Multivariate Cox proportional regression analysis revealed that IFN treatment decreased the risk ratio for overall death to 0.521 (confidence interval [CI]: 0.263-1.034) and for liver-related death to 0.208 (CI: 0.088-0.495) compared with untreated patients, and sustained virologic response showed a decrease in the risk ratio for overall death to 0.219 (CI: 0.068-0.710) and for liver-related death to 0.030 (CI: 0.003-0.267). IFN treatment showed no association with liver-unrelated death. Furthermore, the standardized mortality ratios for all causes of death and liver-related death were reduced in IFN-treated patients compared with untreated patients (1.4 vs. 2.0 for total death and 7.9 vs. 19.7 for liver-related death). In conclusion, the present data suggest that IFN therapy has a long-term clinical benefit for patients with chronic hepatitis C patients by reducing liver-related death, especially in patients with sustained virologic response.