Natural history of hepatitis C
Natural history of hepatitis C
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DOI：
10.1016/j.jhep.2014.07.012
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发表时间：
2014-11-01
影响因子：
25.7
通讯作者：
Dusheiko, Geoffrey
中科院分区：
文献类型：
--
作者：
Westbrook, Rachel H.;Dusheiko, Geoffrey
长期以来有证据表明，丙型肝炎可导致高比例感染者持续感染，并可发展为慢性肝病、肝硬化和肝细胞癌（HCC）。从急性到慢性丙型肝炎的转变通常是亚临床的。由于急性丙型肝炎悄无声息地发病，很难对其清除时间进行准确的研究。HCV自发消退的可能性与多种遗传因素有关，包括IL28B遗传和主要组织相容性复合体II类的DQB1*0301等位基因。大多数数据表明，在急性期消退而不进展为慢性疾病并不伴有重大疾病，但在抗HCV阳性和HCV RNA阴性的个体中观察到轻微的组织学病变。在清除急性丙型肝炎后，再次感染的风险仍然存在。据报道，在男男性行为者（MSM）中，性传播感染率很高。在西方世界，慢性丙型肝炎病毒感染是终末期肝病、肝细胞癌（HCC）和肝脏相关死亡的主要原因。这种慢性疾病的自然史仍不完全清楚。它通常是一种缓慢进展的疾病，以持续的肝脏炎症为特征，在20-30年的HCV感染中，约10-20%的患者会发展为肝硬化。然而，已发表的数据表明肝硬化的进展率各不相同。总的来说，一旦发生肝硬化，每年有1-5%的HCC风险和3-6%的肝脏失代偿风险。在一次失代偿发作后，第二年的死亡风险在15%到20%之间。慢性感染者人数众多、疾病负担沉重以及缺乏疫苗表明，治疗将成为疾病控制的一部分，但治疗对不同群体的影响、有效性和结果仍不确定。几项研究和荟萃分析得出结论，用抗病毒治疗根除HCV可降低慢性丙型肝炎患者发生HCC的风险，与纤维化分期无关，但风险并未消除。(C) 2014欧洲肝脏研究协会。Elsevier B.V.版权所有。
There has long been evidence that hepatitis C can lead to persistent infection in a high proportion of infected individuals, and can progress to chronic liver disease, cirrhosis and hepatocellular carcinoma (HCC). The transition from acute to chronic hepatitis C is usually sub-clinical. Accurate studies of the time course for clearance of acute hepatitis C are difficult to carry out because of the silent onset of the acute disease. The likelihood of spontaneous HCV resolution is associated with several genetic factors, including IL28B inheritance and the DQB1*0301 allele of the major histocompatibility complex class II. Most data suggest that resolution in the acute phase without progression to chronic disease is not accompanied by significant disease, but minor histological lesions have been observed in anti-HCV positive, HCV RNA negative individuals. The risk of reinfection remains a possibility after clearance of acute hepatitis C. High rates of sexually-transmitted infection are being reported in HIV positive men who have sex with men (MSM). Chronic infection with HCV is the leading cause of end-stage liver disease, hepatocellular carcinoma (HCC) and liver related death in the Western world. The natural history of the chronic disease remains incompletely defined. It is generally a slowly progressive disease characterized by persistent hepatic inflammation, leading to the development of cirrhosis in approximately 10-20% of patients over 20-30 years of HCV infection. However, the published data indicate varying progression rates to cirrhosis. Overall, once cirrhosis has developed there is a 1-5% annual risk of HCC and a 3-6% annual risk of hepatic decompensation. Following an episode of decompensation the risk of death in the following year is between 15% and 20%. The high number of chronically infected individuals, the burden of disease, and the absence of a vaccine indicates that treatment will form part of the disease control but the impact, effectiveness and outcomes of treatment in various groups remain uncertain. Several studies and meta-analysis have concluded that eradication of HCV with antiviral therapy reduces the risk of HCC in patients with chronic hepatitis C, independent of fibrosis stage, but the risk is not eliminated. (C) 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.