Increased Rate of Death Related to Presence of Viremia Among Hepatitis C Virus Antibody-Positive Subjects in a Community-Based Cohort Study
Increased Rate of Death Related to Presence of Viremia Among Hepatitis C Virus Antibody-Positive Subjects in a Community-Based Cohort Study
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DOI：
10.1002/hep.23002
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发表时间：
2009-08-01
期刊：
影响因子：
13.5
通讯作者：
Tsubouchi, Hirohito
中科院分区：
文献类型：
--
作者：
Uto, Hirofumi;Stuver, Sherri O.;Tsubouchi, Hirohito
丙型肝炎病毒（HCV）感染患者的总体死亡率尚未完全阐明。本研究分析了在日本HCV高流行区进行的一项基于社区的前瞻性队列研究中HCV抗体（抗HCV）阳性受试者的死亡率。在1995年开始的10年期间，C镇的1125名抗HCV血清阳性居民被纳入研究，并随访至2005年的死亡率。通过死亡证明评估死亡原因。具有可检测到的HCV核心抗原（HCVcAg）或HCV RNA的受试者被认为患有丙型肝炎病毒血症并被归类为HCV携带者; HCVcAg和HCV RNA均阴性的受试者（即，病毒血症阴性）被认为具有先前的HCV感染并且被分类为HCV非携带者。在纳入分析的抗-HCV阳性受试者中，758例（67.4%）为HCV携带者，367例为非携带者。在平均8.2年的随访中，这些受试者中共有231人死亡：HCV携带者组176人死亡，非携带者组55人死亡。经年龄和性别校正后，HCV携带者的总体死亡率高于非携带者（风险比，1.53; 95%可信区间，1.13-2-07）。尽管HCV携带者中肝脏相关死亡发生率更高（风险比为5.94; 95%可信区间为2.58-13-7），但HCV携带者和非携带者之间其他死因的发生率没有差异。在HCV携带者中，较高的HCVcAg水平（>= 100 pg/mL）和持续升高的丙氨酸氨基转移酶水平是肝脏相关死亡率的重要预测因素。结论：在日本，病毒血症的存在增加了抗-HCV血清阳性者的死亡率，主要是由于与five相关的死亡。（《肝脏病学》2009年;50：393-399。）
The overall mortality of patients infected with hepatitis C virus (HCV) has not been fully elucidated. This study analyzed mortality in subjects positive for antibody to HCV (anti-HCV) in a community-based, prospective cohort study conducted in an HCV hyperendemic area of Japan. During a 10-year period beginning in 1995, 1125 anti-HCV-seropositive residents of Town C were enrolled into the study and were followed for mortality through 2005. Cause of death was assessed by death certificates. Subjects with detectable HCV core antigen (HCVcAg) or HCV RNA were considered as having hepatitis C viremia and were classified as HCV carriers; subjects who were negative for both HCVcAg and HCV RNA (i.e., viremia-negative) were considered as having had a prior HCV infection and were classified as HCV noncarriers. Among the anti-HCV-positive subjects included in the analysis, 758 (67.4%) were HCV carriers, and 367 were noncarriers. A total of 231 deaths occurred in these subjects over a mean follow-up of 8.2 years: 176 deaths in the HCV carrier group and 55 in the noncarrier group. The overall mortality rate was higher in HCV carriers than in noncarriers, adjusted for age and sex (hazard ratio, 1.53; 95% confidence interval, 1.13-2-07). Although liver-related deaths occurred more frequently among the HCV carriers (hazard ratio, 5.94; 95% confidence interval, 2.58-13-7), the rates of other causes of death did not differ between HCV carriers and noncarriers. Among HCV carriers, a higher level of HCVcAg (>= 100 pg/mL) and persistently elevated alanine aminotransferase levels were important predictors of fiver-related mortality. Conclusion: The presence of viremia increases the rate of mortality, primarily due to fiver-related death, among anti-HCV-seropositive persons in Japan. (HEPATOLOGY 2009;50:393-399.)