在现实世界的跨国队列中,肝炎C治疗后的长期死亡率
Fanpu Ji1, Sally Tran2, Hidenori Toyoda3
1Department of Hepatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
概括
用直接作用抗病毒药物 (DAA) 治愈型肝炎与更好的结果有关,但需要澄清治疗后的详细死亡风险. 这项研究确定了年龄,性别,肝硬化和糖尿病是DAA治愈患者的关键死亡风险因素.
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:
- 直接作用的抗病毒药物 (DAA) 有效地治疗C型肝炎病毒 (HCV) 感染.
- 虽然DAA介导的HCV治愈与改善的患者结果相关,但对治疗后死亡风险因素的综合数据仍然有限.
- 了解这些风险因素对于长期患者管理和公共卫生战略至关重要.
研究的目的:
- 调查详细的死亡率,并确定在DAA治疗HCV后实现持续病毒学反应 (SVR) 的患者的相关风险因素.
- 提供有关不同患者亚组的死亡率和死亡原因的细粒度数据,包括患有肝硬化和没有肝硬化的人.
主要方法:
- 从39个国际中心对10,034名DAA-SVR的HCV患者进行了回顾性分析.
- 计算每1000个患者年 (PY) 的全因死亡率.
- 根据肝硬化状态进行分层 (非肝硬化,补偿,减补) 并确定死亡风险因素 (年龄,性别,糖尿病).
主要成果:
- 整体死亡率为每1000个PY10.4,而非补偿性肝硬化病的死亡率显著更高 (每1000个PY60.0).
- 总体而言,五年累积生存率为95.1%,在不补偿性肝硬化中降至73.9%.
- 确定了关键的死亡风险因素:年龄超过65岁 (3.2倍),男性性别 (1.5倍),去补偿性肝硬化 (7.6倍) 和基线糖尿病 (DM) (1.5倍).
- 与肝脏相关的死亡在非补偿性肝硬化中占主导地位,而非肝脏相关的死亡在非肝硬化和补偿性肝硬化组中更为常见.
结论:
- 根据年龄,性别,纤维化阶段和DM状态,DAA-SVR患者死亡率和死亡原因存在显著差异.
- 这些发现支持了对精准医学方法在治疗HCV患者治疗后的需要.
- 细粒度子组数据可以为个性化护理,未来的流行病学建模和公共卫生规划提供信息.
相关概念视频
01:26Diseases of the Liver and Gallbladder
2.1K
Liver and gallbladder diseases are a significant health concern, with prominent conditions including cirrhosis, hepatitis, non-alcoholic fatty liver disease (NAFLD), and gallstones. Jaundice is a common manifestation of liver and biliary disease.
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not...
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not...
2.1K
01:10Retrovirus Life Cycles
49.9K
Retroviruses have a single-stranded RNA genome that undergoes a special form of replication. Once the retrovirus has entered the host cell, an enzyme called reverse transcriptase synthesizes double-stranded DNA from the retroviral RNA genome. This DNA copy of the genome is then integrated into the host’s genome inside the nucleus via an enzyme called integrase. Consequently, the retroviral genome is transcribed into RNA whenever the host’s genome is transcribed, allowing the...
49.9K
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
225
In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
225
01:16Hepatic Drug Excretion: Influencing Factors
651
The biliary system of the liver, crucial for bile secretion and drug excretion, comprises intrahepatic bile ducts that merge to form the common hepatic duct. This duct, carrying hepatic bile, combines with the cystic duct, draining the gallbladder and forming the common bile duct, which empties into the duodenum. Bile, produced by hepatic cells lining the bile canaliculi, is composed primarily of water, bile salts, pigments, electrolytes, and lesser amounts of cholesterol and fatty acids. Bile...
651
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow
273
Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug...
273