摘要
目的 对乙型肝炎的自然史进行研究，为其预后判断、药物疗效的分析及药品经济学评估提供佐证。方法 采用回顾性方法随访６～１８年前经肝穿病理组织学诊断的１８３例慢性乙型肝炎的远期转归、影响因素及其抗病毒治疗的远期作用。结果１８３例慢性乙型肝炎患者累计死亡２０例（１．９３％），发生肝硬化２２例（１１．０２％），肝癌１２例（６．５６％）。累计５、１０、１５年生存率分别为９７．２７％、９１．６２％和８４．４７％。因乙型肝炎及其并发症死亡者占死亡原因的８５．００％。累计肝癌５年、１０年、１５年发生率分别是０． ３．１９％和１１．５６％。对照组２４７例死亡６例（２，４３％），无１例发展为肝硬化和肝癌。慢性乙型肝炎患者的死亡率是普通人群的４．５０倍。二者相比，肝硬化、肝癌和死亡的发生率差异均有显著性（Ｐ＜０．００５）。采用 Ｃｏｘ回归分析，高龄、病理损害重、ＨＢｅＡｇ阳性是肝硬化的危险因素；高龄、病理损害重、男性是死亡的危险因素；未筛选出肝癌的危险因素。结论 慢性乙型肝炎的远期预后不良。
Objective By clarifying the natural history of chronic hepatitis B, to evaluate its long-term therapeutic outcome, antiviral drugs efficacy and economic significance. Methods A cohort of 183 (mean age of 31.75 ± 8.03 years, male/female ratio: 152:3 1) chronic hepatitis B patients with biopsy-proven and 247 cases of general population as control were followed up by retrospective cohort study. The follow-up time was 11.81±4.08 years. This study was focused on long-term clinical outcome including the rate of liver cirrhosis, hepatocellular carcinoma and death, the long-term effect of antiviral drugs and prognostic factors. Results In chronic hepatitis B patients, 22(12.02%) developed liver cirrhosis, 12(6.56%) hepatocellular carcinoma, and 20(10.93%) died. The cumulative survival probabilities were 9727%, 91.62%, and 84.47% in 5,10, and 15 years, respectively. The cumulative probabilities of HCC were 0.00%, 3.19%, and 11.56% in 5, 10, and 15 years, respectively. In 247 control subjects, 6 (2.43%) died, none of them developed cirrhosis or HCC. The rates of death, liver cirrhosis, and HCC in hepatitis B patients were markedly different (P<0.005) compared with controls. The overall mortality of hepatitis B patients was 4.50 folds of the general population. Cox multiple regression analysis showed that old age, severe histological injury, and the positive HBeAg were closely related to liver cirrhosis, while old age, severe histological injury, and male were major factors leading to death. The independent variable of predicted HCC was not found. Conclusions The long-term outcome of hepatitis B is poor.
出处
《中华肝脏病杂志》
CAS
CSCD
2002年第1期46-48,共3页
Chinese Journal of Hepatology
基金
中青年肝病科研基金资助项目
关键词
慢性乙型肝炎
病毒性肝炎
自然史
研究
Chronic hepatitis B, chronic
Viral hepatitis
Natural history
