Delta hepatitis within the Veterans Affairs medical system in the United States: Prevalence, risk factors, and outcomes.
Delta hepatitis within the Veterans Affairs medical system in the United States: Prevalence, risk factors, and outcomes.
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DOI：
10.1016/j.jhep.2015.04.025
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发表时间：
2015-09
影响因子：
25.7
通讯作者：
Kaplan DE
中科院分区：
文献类型：
--
作者：
Kushner T;Serper M;Kaplan DE
由于检测率低，美国丁型肝炎患病率的低估计可能是有偏见的。本研究的目的是量化退伍军人健康管理局慢性乙肝患者中检测的流行率，并确定与丁型肝炎阳性状态相关的因素。我们对1999年10月至2013年12月所有乙肝表面抗原检测呈阳性的退伍军人进行了一项全国性的回顾性研究。根据丁型肝炎抗体检测结果将患者分为3组：HDV阳性组、HDV阴性组和HDV未检出组。使用标准统计方法对这些患者组的人口统计学、合并症、额外的实验室数据和临床结果进行比较。在25,603名乙肝表面抗原阳性的患者中，2,175名(8.5%)进行了HDV检测；73名患者(3.4%)检测为阳性。接受HDV检测与接受乙肝病毒、艾滋病毒和丙型肝炎病毒检测有关。HDV阳性结果的预测因素包括药物滥用和肝硬变。符合预先定义的高危特征(ALT异常且HBVDNA滴度被抑制)与HDV检测阳性密切相关(OR 4.2，95%CI 1.9-9.3)。大多数(59%)HDV阳性患者合并感染丙型肝炎病毒。HDV阳性受试者全因死亡的风险更高。丁型肝炎病毒阳性者的肝细胞癌发病率是阴性者的2.9%(p=0.002)。在校正分析中，HDV与肝细胞癌独立相关(OR2.1，95%CI 1.1-3.9)。在美国，慢性乙肝患者的丁型肝炎检测率低得不适当。应探索增加HDV检测的方法，特别是在高危人群中。
Low hepatitis delta prevalence estimates in the United States are likely biased due to low testing rates. The objectives of this study were to quantify the prevalence of testing and identify factors associated with hepatitis D positive status among chronic hepatitis B patients in the Veterans Health Administration We performed a nationwide retrospective study of all veterans who tested positive for HBsAg from October 1999 to December 2013. Hepatitis D antibody testing results were used to stratify patients into 3 groups: HDV-positive, HDV-negative and HDV-not tested. Demographics, comorbidities, additional laboratory data and clinical outcomes were compared across these groups of patients using standard statistical approaches. Among 25,603 patients with a positive hepatitis B surface antigen, 2,175 (8.5%) were tested for HDV; 73 (3.4%) patients tested positive. Receiving HDV testing was associated with receipt of testing for HBV, HIV, and HCV. Predictors of positive HDV results included substance abuse and cirrhosis. Fitting a predefined high-risk profile (abnormal ALT with suppressed HBV DNA titers) was strongly associated with testing positive for HDV (OR 4.2, 95%CI 1.9–9.3). Most (59%) of HDV-positive patients were HCV co-infected. HDV-positive subjects had higher risks of all-cause mortality. Incidence rates of hepatocellular carcinoma were 2.9 fold higher in HDV-positive relative to HDV-negative individuals (p=0.002). In adjusted analyses, HDV was independently associated with HCC (OR 2.1, 95%CI 1.1–3.9). Testing rates for hepatitis delta in chronic hepatitis B patients in the United States are inappropriately low. Approaches to increase testing for HDV particularly in high-risk subsets should be explored.