Changes in the Prevalence of Hepatitis C Virus Infection, Nonalcoholic Steatohepatitis, and Alcoholic Liver Disease Among Patients With Cirrhosis or Liver Failure on the Waitlist for Liver Transplantation.
Changes in the Prevalence of Hepatitis C Virus Infection, Nonalcoholic Steatohepatitis, and Alcoholic Liver Disease Among Patients With Cirrhosis or Liver Failure on the Waitlist for Liver Transplantation.
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DOI：
10.1053/j.gastro.2017.01.003
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发表时间：
2017-04
期刊：
影响因子：
29.4
通讯作者：
Charlton M
中科院分区：
文献类型：
--
作者：
Goldberg D;Ditah IC;Saeian K;Lalehzari M;Aronsohn A;Gorospe EC;Charlton M
随着治疗丙型肝炎病毒（HCV）感染的更有效药物的开发，非酒精性脂肪性肝病（NAFLD）的发病率也在增加。数据表明，肝移植可延长急性肝炎合并酒精性肝病（ALD）患者的生存时间。我们比较了人群中疾病患病率的数据和肝移植等候名单的数据，以评估美国肝脏疾病负担的变化。我们从2010年和2013-2014年两个周期的国家健康和营养检查调查（NHANES）中收集了HCV患病率的数据。我们还从HealthCore综合研究数据库中收集了2006年至2014年肝硬化和慢性肝功能衰竭（CLF）患者的数据，以及2003年至2015年从器官共享联合网络（UNOS）接受移植的患者的数据。我们确定了HCV感染的新候补名单成员和移植受者的百分比，根据移植适应症进行分层，使用Spearman秩相关、趋势的非参数检验和线性回归模型将每个日历年建模为连续变量。在对NHANES（2013-2014）数据的分析中，我们发现HCV抗体阳性的患者中HCV RNA阳性的比例为0.5 (95% CI, 0.42-0.55)；该值显著低于2010年（0.64;95% CI, 0.59-0.73） （P= 0.03）。来自HealthCore数据库的数据显示，随着时间的推移，代偿性肝硬化患者的百分比（HCV或ALD肝硬化患者的百分比下降，但非酒精性脂肪性肝炎[NASH]肝硬化患者的百分比增加）、CLF （HCV或ALD导致CLF患者的百分比下降，NASH导致CLF患者的百分比几乎增加了3倍）、和肝细胞癌（HCC） （HCV或ALD导致的HCC患者百分比下降，NASH患者中HCC的百分比略有增加）。来自UNOS的数据显示，在新进入肝移植等待名单或正在接受肝移植的CLF患者中，HCV感染的百分比显着下降，而NAFLD或ALD患者的百分比显着增加。在新进入肝移植等待名单或接受肝移植的HCC患者中，HCV感染、NAFLD或ALD的比例在2003年至2015年间没有变化。在对3个不同数据库（NHANES、HealthCore和UNOS）的分析中，我们发现慢性HCV感染的肝移植等待名单或接受肝移植的患者比例在减少，肝硬化或CLF患者减少。然而，尽管整个肝硬化患者群体的疾病相对负担不同，但NASH或ALD患者等待或接受肝移植的比例正在增加。
Concurrent to development of more effective drugs for treatment of hepatitis C virus (HCV), infection, there has been an increase in the incidence of non-alcoholic fatty liver disease (NAFLD). Data indicate that liver transplantation prolongs survival times of patient with acute hepatitis associated with alcoholic liver disease (ALD). We compared data on disease prevalence in the population with data from liver transplantation waitlists to evaluate changes in the burden of liver disease in the United States. We collected data on the prevalence of HCV from the National Health and Nutrition Examination Survey (NHANES), from the 2010 and 2013–2014 cycles. We also collected data from the HealthCore Integrated Research Database on patients with cirrhosis and chronic liver failure (CLF) from 2006 through 2014, and data on patients who received transplant from the United Network for Organ Sharing (UNOS), from 2003 through 2015. We determined percentages of new waitlist members and transplant recipients with HCV infection, stratified by indication for transplant, modeling each calendar year as a continuous variable using the Spearman rank correlation, non-parametric test of trends, and linear regression models. In an analysis of data from the NHANES (2013–2014), we found that the proportion of patients with a positive HCV antibody who had a positive HCV RNA was 0.5 (95% CI, 0.42–0.55); this value was significantly lower than in 2010 (0.64; 95% CI, 0.59–0.73) (P=.03). Data from the HealthCore databased revealed significant changes (P<.05 for all), over time, in percentages of patients with compensated cirrhosis (decreases in percentages of patients with cirrhosis from HCV or ALD, but increase in percentages of patients with cirrhosis from non-alcoholic steatohepatitis [NASH]), CLF (decreases in percentages of patients with CLF from HCV or ALD, with an almost 3-fold increase in percentage of patients with CLF from NASH), and hepatocellular carcinoma (HCC) (decreases in percentages of patients with HCC from HCV or ALD and a small increase in HCC among persons with NASH). Data from the UNOS revealed that among patients new to the liver transplant waitlist, or undergoing liver transplantation, for CLF, there was a significant decrease in the percentage with HCV infection and increases in percentages of patients with NAFLD or ALD. Among patients new to the liver transplant waitlist, or undergoing liver transplantation, for HCC, proportions of those with HCV infection, NAFLD, or ALD did not change between 2003 and 2015 In an analysis of 3 different databases (NHANES, HealthCore, and UNOS), we found the proportion of patients on the liver transplant waitlist or undergoing liver transplantation for chronic HCV infection to be decreasing, and fewer patients to have cirrhosis or CLF. However, the percentages of patients on the waitlist or receiving liver transplants for NASH or ALD are increasing, despite different relative burdens of disease among the entire population of patients with cirrhosis.