背景:肝细胞癌(HCC)是慢性丙型肝炎病毒(HCV)感染的主要并发症。在血友病(H)男性中,HCV是肝脏疾病的主要原因。直接作用抗病毒剂(DAA)降低HCV病毒载量,但对HCC的影响尚不清楚。
方法:这是一项针对成年H和非血友病(NH)男性出院的回顾性研究,有和没有HCC,由国家住院患者样本(NIS)数据库中的ICD-10代码识别,2016-2018,与DAA可用性。分析包括排放水平权重,以反映国家估计数。分类变量通过Rao-Scott卡方评估,连续变量通过加权简单线性回归评估。通过加权多变量逻辑回归确定HCC的相关性。
结果:在7,674,969名成年男性出院中,在2016-2018年确定了3730H(.04%),其中10.06%患有HCV,1.07%患有HCC,显著高于NH(1.22%和0.27%,分别)所有P<.001。在3年期间(2016-2018年),H和NH的年度HCC发病率相似。在H中,HCC与年龄较大和HCV发病率较高有关,HBV,NASH,终末期肝病,和Charlson合并症(CCI),每个P<.001。在HCC中,H更年轻,更可能是HIV+,每个P<.001,但与NH相比,不太可能饮酒(P=.018)或高脂血症(P=.008)。在多变量回归中,H组HCC的危险因素包括NASH(OR21.6),HCV(OR3.96),CCI(OR1.54),所有P<.001,而HIV和高脂血症是保护性的。
结论:从2016年到2018年,血友病患者的HCC发生率没有显着变化。NASH,HCV,和CCI是DAA时代血友病中HCC的重大风险。
BACKGROUND: Hepatocellular carcinoma (HCC) is a major complication of chronic hepatitis C virus (HCV) infection. Among haemophilic (H) men, HCV is the leading cause of liver disease. Direct-acting antiviral agents (DAA) reduce HCV viral load, but impact on HCC is unknown.
METHODS: This was a retrospective
study of adult H and nonhaemophilic (NH) male discharges, with and without HCC, identified by ICD-10 codes in the National Inpatient Sample (NIS) database, 2016-2018, with DAA availability. Analyses included discharge-level weights to reflect national estimates. Categorical variables were assessed by Rao-Scott chi-square and continuous variables by weighted simple linear regression. HCC correlates were determined by weighted multivariable logistic regression.
RESULTS: Among 7,674,969 adult male discharges, 3730 H (.04%) were identified in 2016-2018, of whom 10.06% had HCV and 1.07% had HCC, significantly higher than NH (1.22% and .27%, respectively) all P < .001. Annual HCC rates were similar during the 3-year period (2016-2018) in H and NH. Among H, HCC is associated with older age and higher rates of HCV, HBV, NASH, end-stage liver disease, and Charlson comorbidity (CCI), each P < .001. Among HCC, H were younger and more likely HIV+, each P < .001, but less likely alcoholic (P = .018) or hyperlipidaemic (P = .008) compared to NH. In multivariable regression, risk factors for HCC among H included NASH (OR 21.6), HCV (OR 3.96), CCI (OR1.54), all P < .001, while HIV and hyperlipidaemia were protective.
CONCLUSIONS: From 2016 to 2018, HCC rates did not change significantly in haemophilia discharges. NASH, HCV, and CCI are significant risks for HCC in haemophilia during the DAA-era.