Hepatology：美国HBV感染者死亡原因分析

HBV是一种严重的全球性感染性疾病，可以导致肝硬化，肿瘤及肝功能失代偿，严重的会导致死亡。虽然全球某些有关于对HBV患者生存的长期报道（台湾，意大利），但是其他地区的生存统计仍空缺。日前，来自美国加州Kaiser Permanente（凯萨医疗机构）胃肠病科的Jean-Luc Szpakowski和Lue-Yen Tucker进行了有关美国HBV患者的一项自然病程队列研究，研究结果在线发表于Hepatology上。

研究纳入了6689名感染了HBV最终死亡的凯萨医疗机构健康计划成员，并在从1996年3月1日到2005年12月31日之间进行随访。死亡原因分为HBV-相关疾病（继续细分为肝功能失代偿肝硬化和肝癌两类），其他肿瘤，心血管疾病和其他未知情况。病例研究共纳入3244名女性和3445名男性。其中68.3%是亚太人种（Asian-Pacific Islander，包括亚洲，澳洲及太平洋岛国），11.8%是非西班牙裔的白人，剩下的19.9%为其他或者种族未知。患者的HBV抗病毒药物和既往病史情况不一致（无法分析）。

随访10年，在HBV相关死亡率(4.8%vs1.2%)和总死亡率(8.9%vs4.1%)方面，男性均高于女性；死亡年龄显着伴随患者年龄增加而增加，所有死亡数中的40%是40岁以上合并HBV感染的患者；死于肝癌的患者是死于肝功能失代偿肝硬化患者的两倍；在所有肝癌的死亡患者中，男性占了70%。在进行多因素分析，排除了肝癌和肝功能失代偿肝硬化的分别后，HBV感染患者有意义的因素就只有性别和年龄。

研究结论显示，HBV感染在本研究是超过40%患者死亡的原因，并且患者的死亡率，男性在40岁以上，女性在50岁以上都会明显的增加。男性HBV患者的死亡率是女性HBV患者死亡率的四倍，这一点在亚太人群和非亚太人群中保持一致。HBV相关死亡中，肝癌所导致的死亡是肝功能失代偿肝硬化死亡率的两倍。

与HBV相关的拓展阅读：

• Hepatology：美国HBV感染者死亡原因分析
• JAMA：核苷类似物可使HBV相关肝癌切除术后复发风险降低
• Gastroenterology :HBV携带者尽早治疗更有利
• CJASN:HBV且ALT升高的患者易肾功能减退
• JOCR & Clinical Oncology:HBV感染与淋巴瘤发病风险升高有关
更多信息请点击：有关HBV更多资讯

DOI: 10.1002/hep.26110
PMC:
PMID:

Causes of death in patients with hepatitis B: A natural history cohort study in the United States

Jean-Luc Szpakowski1,§,*, Lue-Yen Tucker2

The natural history of hepatitis B virus (HBV) infection in a U.S. population has not been well described. We identified the causes of death in 6,689 health plan members infected with HBV who were followed between March 1, 1996 and December 31, 2005. Causes of death were grouped into HBV-related (subdivided into decompensated cirrhosis [DCC] and hepatocellular carcinoma [HCC]), cancer, cardiovascular, and other/unknown. The study cohort included 3,244 females and 3,445 males; 68.3% were of Asian-Pacific Islander (API) descent, 11.8% were white (non-Hispanic), and 19.9% were of other or unknown race. Exposure to HBV antivirals and preexisting comorbidities were uncommon. Males had higher overall 10-year death rates than females, both for total deaths (8.9% versus 4.1%) and for HBV-related deaths (4.8% versus 1.2%). The death rate rose markedly with increasing age, and approximately 40% of all deaths in subjects over the age of 40 were HBV related. The death rate from HCC was twice that of DCC. HCC deaths represented 70% of cancer deaths in males and 37% in females. On multivariable analysis, when subjects with antecedent HCC and DCC were excluded, the only significant predictor of HBV mortality in both sexes was age. Conclusion: HBV was the cause of death in over 40% of those who died during the study, and the mortality increased markedly with increasing age over 40 in males and over 50 in females. HBV-related mortality was four times more common in males than in females and was as common in non-Asians as in those of API origin. HBV-related deaths were twice as common from HCC as from DCC. (HEPATOLOGY 2012)

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