Influence of hepatitis delta virus infection on morbidity and mortality in compensated cirrhosis type B
Influence of hepatitis delta virus infection on morbidity and mortality in compensated cirrhosis type B
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DOI：
10.1136/gut.46.3.420
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发表时间：
2000-03-01
期刊：
影响因子：
24.5
通讯作者：
Schalm, SW
中科院分区：
文献类型：
--
作者：
Fattovich, G;Giustina, G;Schalm, SW
背景-丁型肝炎病毒（HDV）感染对B型肝硬化临床病程的影响尚不明确。目的-研究HDV状态对B型肝硬化发病率和死亡率的影响。患者/方法-对200例西欧代偿性肝硬化B型患者进行回顾性队列研究，随访时间中位数为6.6年。结果-诊断时，20%的患者有HDV抗体（抗HDV）;抗HDV阳性患者的中位年龄较低（分别为34岁和48岁）。抗HDV阳性/HBeAg阴性、抗HDV阴性/HBeAg阴性和抗HDV阴性/HBeAg阳性患者的Kaplan-Meier五年肝细胞癌（HCC）概率分别为6%、10%和9%;失代偿的相应数字分别为22%、16%和19%，生存率分别为92%、89%和83%。考克斯回归分析确定年龄、白蛋白浓度、γ-球蛋白浓度和HDV状态为显著的独立预后变量。校正基线时的临床和血清学差异后，抗HDV阳性患者相对于HDV阴性患者的HCC、失代偿和死亡风险（95%置信区间）分别增加3.2（1.0 - 10）、2.2（0.8 - 5.7）和2.0（0.7 - 5.7）倍。抗HDV阳性/HBeAg阴性、抗HDV阴性/HBeAg阴性和抗HDV阴性/HBeAg阳性患者的校正后估计的5年HCC风险分别为13%、4%和2%;失代偿的相应数字分别为18，8和14%，存活率分别为90，95，HDV感染使B型肝硬化患者发生HCC的风险增加3倍，死亡率增加2倍。
Background-The effect of hepatitis delta virus (HDV) infection on the clinical course of cirrhosis type B is poorly defined.Aims-To investigate the impact of HDV status on morbidity and mortality in cirrhosis type B.Patients/Methods-Retrospective cohort study of 200 Western European patients with compensated cirrhosis type B followed for a median period of 6.6 years.Results-At diagnosis, 20% of patients had antibodies to HDV (anti-HDV); median age was lower in anti-HDV positive cirrhotics (34 v 48 years respectively). Kaplan-Meier five year probability of hepatocellular carcinoma (HCC) was 6, 10, and 9% in anti-HDV positive/HBeAg negative, anti-HDV negative/HBeAg negative, and anti-HDV negative/HBeAg positive cirrhotics respectively; the corresponding figures for decompensation were 22, 16, and 19% and for survival they were 92, 89, and 83% respectively. Cox regression analysis identified age, albumin concentration, gamma-globulin concentration, and HDV status as significant independent prognostic variables. After adjustment for clinical and serological differences at baseline, the risk (95% confidence interval) for HCC, decompensation, and mortality was increased by a factor of 3.2 (1.0 to 10), 2.2 (0.8 to 5.7), and 2.0 (0.7 to 5.7) respectively in anti-HDV positive relative to HDV negative cirrhotic patients. The adjusted estimated five year risk for HCC was 13, 4, and 2% for anti-HDV positive/HBeAg negative, anti-HDV negative/HBeAg negative, and anti-HDV negative/HBeAg positive cirrhotics respectively; the corresponding figures for decompensation were 18, 8, and 14% and for survival 90, 95, and 93% respectively.Conclusions-HDV infection increases the risk for HCC threefold and for mortality twofold in patients with cirrhosis type B.