Chronic hepatitis C:Treat or wait? Medical decision making in clinical practice  

作　　者：Claus Niederau Dietrich Hüppe Elmar Zehnter Bernd Mller Renate Heyne Stefan Christensen Rainer Pfaff Arno Theilmeier Ulrich Alshuth Stefan Mauss 

机构地区：[1]Katholische Kliniken Oberhausen,St.Josef Hospital,Klinik für Innere Medizin,Oberhausen 46045,Germany [2]Medical Office for Gastroenterology and Hepatology,Herne 44623,Germany [3]Medical Office for Gastroenterology and Hepatology,Dortmund 44263,Germany [4]Medical Office for Gastroenterology and Hepatology,Berlin 10969,Germany [5]Center for Interdisciplinary Medicine,Münster 48143,Germany [6]Medical Office for Gastroenterology and Hepatology,Gie en 35392,Germany [7]Medical Office for Gastroenterology and Hepatology,Mnchengladbach 41239,Germany [8]Pharma AG Medical Management Virology,Grenzach-Wyhlen 79639,Germany [9]Center for HIV and Hepatogastroenterology,Düsseldorf 40237,Germany

出　　处：《World Journal of Gastroenterology》2012年第12期1339-1347,共9页世界胃肠病学杂志（英文版）

基　　金：Supported by Investigator fees from by Roche Pharma AG Germany for contributing data to the study

摘　　要：AIM:To analyzes the decision whether patients with chronic hepatitis C virus (HCV) infection are treated or not.METHODS:This prospective cohort study included 7658 untreated patients and 6341 patients receiving pegylated interferon α2 a/ribavirin,involving 434 physicians/institutions throughout Germany (377 in private practice and 57 in hospital settings).A structured questionnaire had to be answered prior to the treatment decision,which included demographic data,information about the personal life situation of the patients,anamnesis and symptomatology of hepatitis C,virological data,laboratory data and data on concomitant diseases.A second part of the study analyzes patients treated with pegylated interferon α2a.All questionnaires included reasons against treatment mentioned by the physician.RESULTS:Overall treatment uptake was 45%.By multivariate analysis,genotype 1/4/5/6,HCV-RNA ≤ 520 000 IU/mL,normal alanine aminotransferase (ALT),platelets ≤ 142 500/μL,age > 56 years,female gender,infection length > 12.5 years,concomitant diseases,human immunodeficiency virus co-infection,liver biopsy not performed,care in private practice,asymptomatic disease,and unemployment were factors associated with reduced treatment rate.Treatment and sustained viral response rates in migrants (1/3 of cohort) were higher than in German natives although 1/3 of migrants had language problems.Treatment rate and liver biopsy were higher in clinical settings when compared to private practice and were low when ALT and HCV-RNA were low.CONCLUSION:Some reasons against treatment were medically based whereas others were related to fears,socio-economical problems,and information deficits both on the side of physicians and patients.AIM： To analyzes the decision whether patients withchronic hepatitis C virus （HCV） infection are treated or not.METHODS： This prospective cohort study included 7658 untreated patients and 6341 patients receiving pegylated interferon .α2a/ribavirin, involving 434 physicians/institutions throughout Germany （377 in private practice and 57 in hospital settings）. A structured questionnaire had to be answered prior to the treatment decision, which included demographic data, information about the personal life situation of the patients, anamnesis and symptomatology of hepatitis C, virological data, laboratory data and data on concomitant diseases. A second part of the study analyzes patients treated with pegylated interferon α2a. All questionnaires included reasons against treatment mentioned by the physician.RESULTS： Overall treatment uptake was 45%. By multivariate analysis, genotype 1/4/5/6, HCV-RNA ≤ 520 000 IU/mL, normal alanine aminotransferase （ALT）, platelets ≤142 500/μL, age 〉 56 years, female gender, infection length 〉 12.5 years, concomitant diseases, human immunodeficiency virus co infection, liver biopsy not performed, care in private practice, asymptomatic disease, and unemployment were factors associated with reduced treatment rate. Treatment and sustained viral response rates in migrants （1/3 of cohort） were higher than in German natives although 1/3 of migrants had language problems. Treatment rate and liver biopsy were higher in clinical settings when compared to private practice and were low when ALT and HCV-RNA were low.CONCLUSION： Some reasons against treatment were medically based whereas others were related to fears, socio-economical problems, and information deficits both on the side of physicians and patients.

关 键 词：Hepatitis C virus Interferon  Ribavirin LIVERCIRRHOSIS MIGRANTS Treatment barrier 

分 类 号：R512.63[医药卫生—内科学]