欧洲的一项研究显示,丙型肝炎合并代偿期肝硬化患者的 5 年生存率为 91%,10 年生存率为 79%。[42]National Institutes of Health. National Institutes of Health consensus development conference statement: management of hepatitis C: 2002 - June 10-12, 2002. Hepatology. 2002;36(suppl 1):S3-S20.http://www.ncbi.nlm.nih.gov/pubmed/12407572?tool=bestpractice.com[71]Fattovich G, Guistina G, Degos F, et al. Morbidity and mortality in compensated cirrhosis type C: a retrospective follow-up study of 384 patients. Gastroenterology. 1997;112:463-472.http://www.ncbi.nlm.nih.gov/pubmed/9024300?tool=bestpractice.com 代偿期肝硬化患者 5 年肝功能失代偿几率为 18%,10 年几率为 30%。[72]Niederau C, Lange S, Heintges T, et al. Prognosis of chronic hepatitis C: results of a large, prospective cohort study. Hepatology. 1998;28:1687-1695.http://www.ncbi.nlm.nih.gov/pubmed/9828236?tool=bestpractice.com[73]Planas R, Balleste B, Alvarez MA, et al. Natural history of decompensated hepatitis C virus-related cirrhosis: a study of 200 patients. J Hepatol. 2004;40:823-830.http://www.ncbi.nlm.nih.gov/pubmed/15094231?tool=bestpractice.com 失代偿期肝硬化患者 5 年生存率仅为 50%。尽管罕见,但是在持续病毒学应答后可能复发。[74]Jacobson IM, Lim JK, Fried MW. American Gastroenterological Association Institute clinical practice update - expert review: care of patients who have achieved a sustained virologic response after antiviral therapy for chronic hepatitis C infection. Gastroenterology. 2017;152:1578-1587.http://www.gastrojournal.org/article/S0016-5085(17)30327-X/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/28344022?tool=bestpractice.com
一项意大利研究对近 200 例感染丙型肝炎病毒 (HCV) 的代偿性肝硬化患者前瞻性随访 14 年,结果显示,死亡风险约为每年 2.5%,但如果在基线期存在食管静脉曲张,则年死亡风险加倍 (5%)。这也证实了基因 1b 型(世界范围内最常见的基因型)与肝癌发生率、肝功能失代偿发生率、死亡率密切相关。[75]Bruno S, Zuin M, Crosignani A, et al. Predicting mortality risk in patients with compensated HCV-induced cirrhosis: a long-term prospective study. Am J Gastroenterol. 2009;104:1147-1158.http://www.ncbi.nlm.nih.gov/pubmed/19352340?tool=bestpractice.com 基因 3 型与肝硬化和肝癌的发生率增加相关。[76]Kanwal F, Kramer JR, Ilyas J, et al. HCV genotype 3 is associated with an increased risk of cirrhosis and hepatocellular cancer in a national sample of US Veterans with HCV. Hepatology. 2014;60:98-105.http://www.ncbi.nlm.nih.gov/pubmed/24615981?tool=bestpractice.com
死亡率不断增加,在美国,与 HCV 相关的死亡数量现在已经超过与 HIV/AIDS 相关的死亡数量。在 2014 年,HCV 导致的死亡数量是 19,659 例(每 100,000 人中有 5 例死亡),主要是 55 至 64 岁的患者(每 100,000 人中有 25 例死亡,占所有 HCV 相关死亡的 50.9%)。男性的死亡率大约是女性的 2.6 倍。[12]Centers for Disease Control and Prevention. Surveillance for viral hepatitis - United States, 2014: hepatitis C. November 2016. http://www.cdc.gov/ (last accessed 27 September 2017).http://www.cdc.gov/hepatitis/Statistics/2012Surveillance/Commentary.htm#hepC
美国一项基于人群的研究发现,HCV 感染患者过高的死亡风险可能归因于可以纠正的健康风险行为(即吸烟、饮酒或使用违禁药物、体力活动不足和不健康的饮食),而不是 HCV 感染本身。[77]Innes H, McAuley A, Alavi M, et al. The contribution of health risk behaviours to excess mortality in American adults with chronic hepatitis C: A population cohort-study. Hepatology. 2017 Aug 4 [epub ahead of print].http://onlinelibrary.wiley.com/doi/10.1002/hep.29419/epdfhttp://www.ncbi.nlm.nih.gov/pubmed/28777874?tool=bestpractice.com