全国队列中丁型肝炎病毒感染与肝细胞癌、肝失代偿、全因死亡和肝脏相关死亡的关联。
Association of hepatitis delta virus infection and hepatocellular carcinoma, hepatic decompensation, all-cause and liver-related death in a national cohort.
发表日期：2024 Sep 10
作者：
Binu V John, Dustin Bastaich, Mahmoud Manouchehri Amoli, Robert J Wong, Donna M Evon, Shari S Rogal, David B Ross, Timothy R Morgan, Seth A Spector, Gabriel Villada, Hann-Hsiang Chao, Bassam Dahman,
来源：
HEPATOLOGY
摘要：
丁型肝炎病毒 (HDV) 感染是最严重的慢性肝炎。然而，缺乏对美国出生人群的死亡结果和死因（主要是丁型肝炎病毒水平传播）的研究。本研究的目的是对丁型肝炎患者进行一项全国性研究，以了解与乙型肝炎病毒 (HBV) 患者相比的自然史和结果。在 23 年期间对 4,817 名 HBV 感染退伍军人进行 HDV 检测（99.6% 美国出生，3.3% HDV 阳性）的全国队列中，我们使用多变量模型来确定与肝细胞癌复合结果相关的因素（与 HBV 单一感染相比，HDV 合并感染（相对于 HBV 单一感染）与复合性肝病的发生率显着升高相关分别在 5 年（23.84 vs. 7.98，p<0.001）和 10 年（19.14 vs. 10.18，p<0.001）的相关结果。最常见的死亡原因是肝脏相关（HDV 为 33.8%，HBV 为 24.7%），其次是非肝恶性肿瘤（15.6% vs. 14.8%）、心脏疾病（11.7% vs. 15.2%）和肺部疾病（5.2% vs. 3.7%）。在多变量模型中，HDV 与复合肝脏结局（aHR 2.57，95% CI 1.87-3.52，p<0.001）和全因死亡率（aHR 1.52，95% CI 1.20-1.93，p<0.001）风险增加相关）。在美国出生的退伍军人群体中，HDV 合并感染与肝脏相关结果和全因死亡率风险增加相关。我们的研究结果支持广泛检测以早期识别 HDV。版权所有 © 2024 美国肝病研究协会。
Hepatitis Delta Virus (HDV) infection is the most severe form of chronic hepatitis. However, studies on outcomes and causes of death in a United States-born population, with primarily horizontal transmission of HDV, are lacking. The aim of this study was to conduct a national study of patients with hepatitis D to understand the natural history and outcomes compared to patients with hepatitis B virus (HBV). infection.In a national cohort of 4,817 HBV infected veterans tested for HDV (99.6% US-born, 3.3% HDV positive) over a 23-year period, we used multivariable models to identify the factors associated with a composite outcome of hepatocellular carcinoma (HCC), decompensation, and liver-related mortality (LRM), as well as all-cause mortality of patients with HDV compared to HBV mono-infection.HDV coinfection (vs. HBV monoinfection) was associated with a significantly higher incidence of composite liver-related outcomes at both 5 (23.84 vs. 7.98, p<0.001), and 10 years (19.14 vs. 10.18, p<0.001) respectively. The most common cause of death was liver-related (33.8% for HDV vs. 24.7% for HBV), followed by non-hepatic malignancies, (15.6 vs. 14.8%),cardiac (11.7 vs. 15.2%), and lung disease (5.2 vs. 3.7%). In multivariable models, HDV was associated with an increased risk of composite liver outcomes (aHR 2.57, 95% CI 1.87-3.52, p<0.001), and all-cause mortality (aHR 1.52, 95% CI 1.20-1.93, p<0.001).In a predominantly U.S born cohort of Veterans, HDV co-infection was associated with an increased risk of liver-related outcomes and all-cause mortality. Our findings support widespread testing for early identification of HDV.Copyright © 2024 American Association for the Study of Liver Diseases.