Natural history of chronic hepatitis C
Natural history of chronic hepatitis C
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DOI：
10.1053/jhep.2002.36806
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发表时间：
2002-11-01
期刊：
影响因子：
13.5
通讯作者：
Seeff, LB
中科院分区：
文献类型：
--
作者：
Seeff, LB
围绕丙型肝炎病毒（HCV）感染的自然史问题存在许多争议。许多权威人士认为这种疾病是不可避免的进展，随着时间的推移，很有可能发展为肝硬化，偶尔也会发展为肝细胞癌（HCC），因此很可能导致死亡。另一些人则认为慢性丙型肝炎的结局是可变的，大多数感染者不会死于这种疾病，但更有可能死于伴随这种病原体感染的合并症，或者死于更常见的疾病。分歧可能源于研究的进行方式和研究的人群。确定自然历史的努力受到疾病的主要特征的阻碍，即它的发病很少被认识到，病程非常长。因此，回顾性研究的结果与前瞻性研究的结果不同，但两者都得出结论，至少20%的慢性感染成人在20年内发展为肝硬化。最近采用回顾性/前瞻性方法的研究，主要集中在年轻的感染者身上，得出了不同的结果。在这些年轻人中，特别是年轻女性，病毒感染的自发消退比以前认为的更常见，其中5%或更少的人被确定为肝硬化。所有被研究的群体，无论是年轻的还是年老的，主要的失败是自然史研究很少超过前20年，所以除了通过建模之外，这段时间之后的结果是未知的。一些与宿主有关的和外来的因素可能影响自然历史。
Much controversy surrounds the issue of the natural history of hepatitis C virus (HCV) infection. Many authorities view the disease as inexorably progressive with a high probability of advancing over time to cirrhosis and occasionally hepatocellular carcinoma (HCC) and, therefore, likely to be responsible for causing death. Others regard chronic hepatitis C as having a variable outcome, the majority of infected persons not dying from the disease, but more likely from the comorbid conditions that so often accompany infection by this agent, or from more common medical conditions. Disagreements probably derive from the manner of conduct of the study and the populations studied. Efforts to determine natural history are handicapped by the primary characteristics of the disease, namely that its onset rarely is recognized and its course is prolonged exceedingly. Thus, different outcomes have come from retrospective rather than from prospective studies, but both have concluded that at least 20% of chronically infected adults develop cirrhosis within 20 years. More recent studies that used a retrospective/prospective approach, focusing largely on young infected individuals, have produced different results. Among these young people, particularly young women, spontaneous resolution of the viral infection is more common than previously thought and cirrhosis has been identified in 5% or fewer of them. The major failing for all groups studied, young and old, is that natural history studies have rarely exceeded the first 2 decades, so that outcome beyond this time is not known, other than through modeling. Several host-related and extraneous factors probably affect the natural history.