HBV感染在美国的自然史还没有得到很好的描述。在1996年3月1日至2005年12月31日期间，我们确定了随访的6689位感染乙型肝炎病毒的健康计划成员的死因。死亡原因被分为HBV相关性（分为肝硬化失代偿[DCC]和肝细胞癌[HCC]），癌症，心血管疾病和其他/未知原因。 研究组包括3244名女性和3445名男性；亚洲及太平洋岛民（API）血统占68.3％，白人（非西班牙裔）占11.8％，19.9％为其他种族或种族不明。暴露于乙肝抗病毒药物和预先存在合并症者少见。 男性10年整体死亡率高于女性，不论是总死亡率（8.9％比4.1％）还是乙肝相关死亡率（4.8％比1.2％）。死亡率随着年龄增加而显著上升，且40岁以上者的死因有40%是乙肝相关的。肝细胞癌的死亡率是肝硬化失代偿的两倍。肝细胞癌的死亡人数在男性中占70％，女性中占37％。在多变量分析中，当受试者先前的肝细胞癌和肝硬化失代偿原因被排除在外， HBV死亡率在男女两种性别中唯一的显著自变量是年龄。在研究中，死因的40%以上是由乙型肝炎病毒导致的，且在大于40岁的男性和大于50岁的女性中死亡率明显增加。
吉林大学第一医院肝病科 赵菁 摘译
本文首次发表于[Hepatology,2013,58(1):21-30]
Causes of death in patients with hepatitis B: A natural history cohort study in the United States.
Abstract
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 studycohort 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 deathrates 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 2013).
