摘要
AIM:To evaluate the clinical relevance of each cofactor on clinical presentation of chronic hepatitis B.METHODS:Out of 1366 hepatitis B surface antigen(HBsAg) positive subjects consecutively observed in 79 Italian hospitals,53(4.3%) showed as the only cofactor hepatitis D virus(HDV) infection [hepatitis B virus(HBV)/HDV group],130(9.5%) hepatitis C virus(HCV)(group HBV/HCV),6(0.4%) human immunodeficiencyvirus(HIV)(group HBV/HIV),138(10.2%) alcohol abuse(group HBV/alcohol);109(8.0%) subjects had at least two cofactors and 924 were in the cofactor-free(CF) group.RESULTS:Compared with patients in group CF those in group HBV/alcohol were older and more frequently had cirrhosis(P < 0.001),those in group HBV/HDV were younger(P < 0.001),more frequently resided in the south of the country and had cirrhosis(P <0.001),those in group HBV/HCV were older(P < 0.001) and more frequently had cirrhosis(P < 0.001).These cofactors were all independent predictors of liver cirrhosis in HBsAg positive patients.Multivariate analysis showed that an older age [odds ratio(OR) 1.06,95% CI:1.05-1.08],alcohol abuse with more than 8 drinks daily(OR 2.89,95% CI:1.81-4.62) and anti-HDV positivity(OR 3.48,95% CI:2.16-5.58) are all independently associated with liver cirrhosis.This association was found also for anti-HCV positivity in univariate analysis,but it was no longer associated(OR 1.23,95% CI:0.84-1.80) at multivariate analysis.CONCLUSION:Older age,HDV infection and alcohol abuse are the major determinants of severe liver disease in chronic HBV infection,while HCV replication plays a lesser role in the severity of hepatic damage.
AIM：To evaluate the clinical relevance of each cofactor on clinical presentation of chronic hepatitis B.METHODS：Out of 1366 hepatitis B surface antigen（HBsAg） positive subjects consecutively observed in 79 Italian hospitals,53（4.3%） showed as the only cofactor hepatitis D virus（HDV） infection [hepatitis B virus（HBV）/HDV group],130（9.5%） hepatitis C virus（HCV）（group HBV/HCV）,6（0.4%） human immunodeficiencyvirus（HIV）（group HBV/HIV）,138（10.2%） alcohol abuse（group HBV/alcohol）;109（8.0%） subjects had at least two cofactors and 924 were in the cofactor-free（CF） group.RESULTS：Compared with patients in group CF those in group HBV/alcohol were older and more frequently had cirrhosis（P 0.001）,those in group HBV/HDV were younger（P 0.001）,more frequently resided in the south of the country and had cirrhosis（P 0.001）,those in group HBV/HCV were older（P 0.001） and more frequently had cirrhosis（P 0.001）.These cofactors were all independent predictors of liver cirrhosis in HBsAg positive patients.Multivariate analysis showed that an older age [odds ratio（OR） 1.06,95% CI：1.05-1.08],alcohol abuse with more than 8 drinks daily（OR 2.89,95% CI：1.81-4.62） and anti-HDV positivity（OR 3.48,95% CI：2.16-5.58） are all independently associated with liver cirrhosis.This association was found also for anti-HCV positivity in univariate analysis,but it was no longer associated（OR 1.23,95% CI：0.84-1.80） at multivariate analysis.CONCLUSION：Older age,HDV infection and alcohol abuse are the major determinants of severe liver disease in chronic HBV infection,while HCV replication plays a lesser role in the severity of hepatic damage.
基金
Supported by A grant from the Progetto di Ricerca di Interesse Nazionale 2000
in part with a grant from the Viral Hepatitis Project
Istituto Superiore di Sanità,D.leg.vo 30/12/1992 n.502
