The natural history of compensated cirrhosis due to hepatitis C virus: A 17-year cohort study of 214 patients
The natural history of compensated cirrhosis due to hepatitis C virus: A 17-year cohort study of 214 patients
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DOI：
10.1002/hep.21176
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发表时间：
2006-06-01
期刊：
影响因子：
13.5
通讯作者：
Colombo, Massimo
中科院分区：
文献类型：
--
作者：
Sangiovanni, Angelo;Prati, Gian Maria;Colombo, Massimo
需要对连续患者进行足够长时间随访的大型数据库，以确定肝硬化并发症的发生率、时间顺序和等级，以及其他潜在肝病原因的重要性。根据这一目标，对一组丙型肝炎病毒（HCV）所致代偿性肝硬化患者进行了17年随访。前瞻性招募了214例HCV RNA血清阳性的Child-Pugh A级肝硬化患者，这些患者以前没有临床失代偿，并定期进行临床和腹部超声检查。在114个月（范围1-199）内，68例（32%）发生肝细胞癌（HCC），50例（23%）发生腹水，36例（17%）发生黄疸，13例（6%）发生上消化道出血，2例（1%）发生脑病，年发病率分别为3.9%、2.9%、2.0%、0.7%和0.1%。154例（72%）的临床状态保持不变，45例（21%）进展为Child-Pugh B级，15例（7%）进展为C级。肝癌是死亡的主要原因（44%），58例（27%）患者的第一个并发症，其次是腹水29例（14%），黄疸20例（9%），上消化道出血3例（1%）。年死亡率为每年4.0%，有其他潜在肝病原因的患者高于无其他潜在肝病原因的患者（5.7% vs. 3.6%; P = 0.04）。总之，丙型肝炎相关肝硬化是一种缓慢进行的疾病，可能会被其他潜在的肝病原因加速。HCC是最先发生的并发症，也是死亡率增加的主要原因。
Large databases of consecutive patients followed for sufficiently long periods are needed to establish the rates, chronology, and hierarchy of complications of cirrhosis as well as the importance of other potential causes of liver disease. In accordance with this goal, a cohort of patients with compensated cirrhosis due to hepatitis C virus (HCV) was followed for 17 years. Two hundred and fourteen HCV RNA-seropositive patients with Child-Pugh class A cirrhosis who had no previous clinical decompensation were prospectively recruited and followed up with periodic clinical and abdominal ultrasound examinations. During 114 months (range 1-199), hepatocellular carcinoma (HCC) developed in 68 (32%), ascites in 50 (23%), jaundice in 36 (17%), upper gastrointestinal bleeding in 13 (6%), and encephalopathy in 2 (1%), with annual incidence rates of 3.9%, 2.9%, 2.0%, 0.7%, and 0.1%, respectively. Clinical status remained unchanged in 154 (72%) and progressed to Child-Pugh class B in 45 (21%) and class C in 15 (7%). HCC was the main cause of death (44%) and the first complication to develop in 58 (27%) patients, followed by ascites in 29 (14%), jaundice in 20 (9%), and upper gastrointestinal bleeding in 3 (1%). The annual mortality rate was 4.0% per year and was higher in patients with other potential causes of liver disease than in those without them (5.7% vs. 3.6%; P =.04). In conclusion, hepatitis C-related cirrhosis is a slowly progressive disease that may be accelerated by other potential causes of liver disease. HCC was the first complication to develop and the dominant cause for increased mortality.