活下来 肝炎C-了解死亡和生存 超越治愈
Paul J Clark1, Patricia C Valery2, Simone I Strasser3
1Department of Gastroenterology, Princess Alexandra and Mater Hospitals, and Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Alimentary pharmacology & therapeutics
|June 19, 2025
概括
治愈型肝炎病毒 (HCV) 感染显著降低了死亡率,但肝硬化,非持续性病毒反应和年龄等因素增加了风险. 针对心理健康,并发症和癌症查的整体护理对于减少HCV治疗后的长期死亡率至关重要.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 病毒学 病毒学
- 公共卫生 公共卫生
背景情况:
- 通过直接作用抗病毒疗法 (DAA) 治愈C型肝炎病毒 (HCV) 会降低肝脏和全因死亡率.
- 然而,即使在成功根除HCV之后,早期死亡的残留风险仍然存在.
- 在DAA治疗后,确定与特定原因死亡率相关的因素对于全面的患者护理至关重要.
研究的目的:
- 调查影响患者因特定原因死亡率的因素,这些患者接受了针对型肝炎病毒 (HCV) 感染的直接作用抗病毒药物 (DAA) 治疗.
- 确定成功治愈HCV后的长期风险和死亡率预测因素.
主要方法:
- 在2016-2021年期间接受DAA治疗的3619名成年患者的队列被跟踪到2023年9月.
- 使用人口数据库获取有关药物,医疗保健利用和死亡率结果的数据.
- 特定原因死亡率,包括与肝脏相关的,自伤/意外中毒和呼吸道原因,是主要终点.
主要成果:
- 在3619名患者中,11.7%的患者死亡,主要原因是肝病 (40.6%),自我伤害/意外中毒 (13.2%),呼吸道疾病/肺癌 (12.3%).
- 肝硬化,FIB4评分>3.25,非持续性病毒学反应 (非SVR) 和年龄≥60岁是肝脏相关死亡率的显著预测因素.
- 非SVR与三倍高的死亡率有关. 诸如使用心理健康药物,失去随访和注射药物使用等因素增加了自伤/意外中毒死亡率的风险.
- 高龄和糖尿病与肝癌和心血管疾病的死亡率增加有关.
结论:
- 与肝脏相关的死亡是HCV治愈后肝硬化患者的主要关注点.
- 实现持续的病毒学反应 (SVR) 对于降低死亡率至关重要.
- 整体的HCV护理策略应包括心理健康支持,代谢性并发症的管理和向癌症查,特别是在老年人中,以减轻过度死亡率.
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