763例肝硬化患者的病因及临床特点分析
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摘要
[目的]探讨肝硬化患者的病因以及临床特点分析,为临床治疗提供参考。[方法]回顾性分析2008-01-2018-01期间住院的763例肝硬化患者的病因、并发症等临床特点。[结果](1)病因构成方面,乙型肝炎肝硬化482例(63.17%),酒精性肝硬化96例(12.58%),乙型肝炎合并酒精性肝硬化62例(8.13%),血吸虫性肝硬化26例(3.41%),自身免疫性肝炎21例(2.75%),隐源性肝硬化19例(2.49%),其他15例(1.97%)。(2)以2013-01为时间节点,将所有患者划分为前后两段时间进行比较,乙型肝炎肝硬化患者人数由75.54%下降至53.89%,差异有统计学意义(χ~2=37.598,P=0.000);酒精性肝硬化由7.65%上升至16.28%,差异有统计学意义(χ~2=12.680,P=0.000);乙型肝炎合并酒精性肝硬化由5.50%上升至10.09%,差异有统计学意义(χ~2=7.670,P=0.006)。(3)肝硬化主要的并发症依次为上消化道出血(21.49%)、原发性肝癌(20.18%))、自发性腹膜炎(12.58%)、肝性脑病(6.95%)和肝肾综合征(3.67%)。乙型肝炎合并酒精性肝硬化患者上消化道出血、原发性肝癌的发病率与单纯乙肝肝硬化(χ~2=18.366,P=0.000;χ~2=5.761,P=0.016)和单纯酒精性肝硬化(χ~2=5.229,P=0.022;χ~2=4.143,P=0.042)相比较,差异有统计学意义。[结论]肝硬化最主要病因仍以乙型肝炎为主,但酒精性肝硬化、乙型肝炎合并酒精性肝硬化的发病率明显增加,上消化道出血、原发性肝癌是肝硬化主要的并发症。
[Objective]To explore the etiology and clinical characteristics of patients with liver cirrhosis in 763 cases. [Methods]We retrospectively analyzed the etiology and complications of 763 patients with cirrhosis which hospitalized from January 2008 to January 2018.[Results](1)In terms of etiology,there were 482 cases(63.17%)of hepatitis B,96 cases(12.58%)of alcoholic fatty liver,62 cases(8.13%)of hepatitis B with alcoholic fatty liver,26 cases(3.41%)of schistosomiasis cirrhosis,and 21 cases(2.75%)of autoimmune liver disease 19 cases(2.49%)of cryptogenic cirrhosis,and 15 cases(1.97%)of other cases.(2)Taking January 2013 as the time boarder,all patients were divided into two periods before and after the time boarder.The number of patients with hepatitis B cirrhosis decreased from 75.54% to 53.89%,the difference was statistically significant(χ~2=37.598,P=0.000).Alcoholic cirrhosis increased from7.65% to 16.28%,the difference was statistically significant(χ~2=12.680,P=0.000);hepatitis B with alcoholic cirrhosis increased from 5.50% to 10.09%,the difference was statistically significant(χ~2=7.670,P=0.006).(3)The main complications of cirrhosis were upper gastrointestinal bleeding(21.49%),primary liver cancer(20.18%),spontaneous peritonitis(12.58%),hepatic encephalopathy(6.95%)and hepatorenal syndrome(3.67%).The incidence of upper gastrointestinal bleeding and primary liver cancer in patients with hepatitis B complicated with alcoholic cirrhosis was significantly higher than that in patients with hepatitis B alone(χ~2=18.366,P=0.000;χ~2=5.761,P=0.016)and those with alcoholic cirrhosis alone(χ~2=5.229,P=0.022;χ~2=4.143,P=0.042).[Conclusion] Hepatitis B is still the main cause of liver cirrhosis in this group,but the proportion of alcoholic liver cirrhosis and hepatitis B with alcoholic liver cirrhosis increased significantly.Upper gastrointestinal bleeding and primary liver cancer are the main complications of liver cirrhosis.
[Objective]To explore the etiology and clinical characteristics of patients with liver cirrhosis in 763 cases. [Methods]We retrospectively analyzed the etiology and complications of 763 patients with cirrhosis which hospitalized from January 2008 to January 2018.[Results](1)In terms of etiology,there were 482 cases(63.17%)of hepatitis B,96 cases(12.58%)of alcoholic fatty liver,62 cases(8.13%)of hepatitis B with alcoholic fatty liver,26 cases(3.41%)of schistosomiasis cirrhosis,and 21 cases(2.75%)of autoimmune liver disease 19 cases(2.49%)of cryptogenic cirrhosis,and 15 cases(1.97%)of other cases.(2)Taking January 2013 as the time boarder,all patients were divided into two periods before and after the time boarder.The number of patients with hepatitis B cirrhosis decreased from 75.54% to 53.89%,the difference was statistically significant(χ~2=37.598,P=0.000).Alcoholic cirrhosis increased from7.65% to 16.28%,the difference was statistically significant(χ~2=12.680,P=0.000);hepatitis B with alcoholic cirrhosis increased from 5.50% to 10.09%,the difference was statistically significant(χ~2=7.670,P=0.006).(3)The main complications of cirrhosis were upper gastrointestinal bleeding(21.49%),primary liver cancer(20.18%),spontaneous peritonitis(12.58%),hepatic encephalopathy(6.95%)and hepatorenal syndrome(3.67%).The incidence of upper gastrointestinal bleeding and primary liver cancer in patients with hepatitis B complicated with alcoholic cirrhosis was significantly higher than that in patients with hepatitis B alone(χ~2=18.366,P=0.000;χ~2=5.761,P=0.016)and those with alcoholic cirrhosis alone(χ~2=5.229,P=0.022;χ~2=4.143,P=0.042).[Conclusion] Hepatitis B is still the main cause of liver cirrhosis in this group,but the proportion of alcoholic liver cirrhosis and hepatitis B with alcoholic liver cirrhosis increased significantly.Upper gastrointestinal bleeding and primary liver cancer are the main complications of liver cirrhosis.
引文
[1] 刘斌,张国顺,杨美荣,等.肝硬化并发食管胃底静脉曲张破裂出血与门静脉血栓形成的危险因素[J].世界华人消化杂志,2016,24(18):2892-2897.
[2] 中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1959.
[3] 中华医学会肝病学分会,中华医学会感染病学分会.丙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1961-1959.
[4] 中华医学会肝病学分会脂肪肝和酒精性肝病学组.酒精性肝病诊疗指南(2010年版)[J].中华肝脏病杂志,2010,18(3):167-170.
[5] 王绮夏,蒋翔,连敏,等.2015年欧洲肝病学会临床实践指南:自身免疫性肝炎[J].临床肝胆病杂志,2015,31(12):2000-2019.
[6] 韩英,陈瑜.2017欧洲肝脏病学会原发性胆汁性胆管炎诊治指南解读[J].中华肝脏病杂志,2017,25(11):814-818.
[7] 中华医学会肝病学分会药物性肝病学组.药物性肝损伤诊治指南(2015年版)[J].临床肝胆病杂志,2015,31(11):1752-1769.
[8] LIANG X,BI S,YANG W,et al.Evaluation of the impact of hepalitis B vacination among children born during 1992-2005 in China[J].J Infect Dis,2009,200:39-47.
[9] 王晓霞,邹正升,李保森,等.2002至2011年中国“北方”地区住院肝硬化患者病因构成及变化趋势分析[J].实用肝脏病杂志,2014,17(2):154-158.
[10] 张国顺,刘斌,方正亚,等.HBV感染合并酒精性肝病的失代偿期肝硬化患者的临床特征及预后[J].世界华人消化杂志,2016,24(22):3422-3427.
[11] BIALEK S R,REDD J T,LYNCH A,et al.Chronic liver disease among two American Indian patient populations in the southwestern United States,2000-2003[J].J Clin Gastroenterol,2008,42:949-954.
[12] 王秀珍,刘雪峰.2041例肝硬化病因及并发症分析[J].浙江医学,2017,39(1):37-39.
[13] 高潇雪,刘立新.酒精性肝病流行病学及发病机制研究进展[J].中华消化病与影像杂志:电子版,2016,6(2):62-65.
[14] 周广玉,吴海静.肝硬化合并上消化道出血患者行系统性护理干预对其疗效的影响[J].现代消化及介入诊疗,2016,21(2):352-354.
[15] 王永栋,刘建茹,王莹,等.奥曲肽和普萘洛尔治疗肝硬化上消化道出血对疗效及血流动力学的影响[J].河北医药,2016,34(5):706-708.
[16] 赵铭,丁顺斌,江小云,等.复方甘草酸苷联合还原型谷胱甘肽治疗酒精性肝硬化43例临床疗效分析[J].标记免疫分析与临床,2016,23(1):38-41.
[17] 吴洪秋,张永良,黄坚尧,等.乙肝血清学标志物定量和HBV DNA定量联合检测在乙肝病毒感染诊断中的应用[J].胃肠病学和肝病学杂志,2016,25(4):415-418.
[2] 中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1959.
[3] 中华医学会肝病学分会,中华医学会感染病学分会.丙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1961-1959.
[4] 中华医学会肝病学分会脂肪肝和酒精性肝病学组.酒精性肝病诊疗指南(2010年版)[J].中华肝脏病杂志,2010,18(3):167-170.
[5] 王绮夏,蒋翔,连敏,等.2015年欧洲肝病学会临床实践指南:自身免疫性肝炎[J].临床肝胆病杂志,2015,31(12):2000-2019.
[6] 韩英,陈瑜.2017欧洲肝脏病学会原发性胆汁性胆管炎诊治指南解读[J].中华肝脏病杂志,2017,25(11):814-818.
[7] 中华医学会肝病学分会药物性肝病学组.药物性肝损伤诊治指南(2015年版)[J].临床肝胆病杂志,2015,31(11):1752-1769.
[8] LIANG X,BI S,YANG W,et al.Evaluation of the impact of hepalitis B vacination among children born during 1992-2005 in China[J].J Infect Dis,2009,200:39-47.
[9] 王晓霞,邹正升,李保森,等.2002至2011年中国“北方”地区住院肝硬化患者病因构成及变化趋势分析[J].实用肝脏病杂志,2014,17(2):154-158.
[10] 张国顺,刘斌,方正亚,等.HBV感染合并酒精性肝病的失代偿期肝硬化患者的临床特征及预后[J].世界华人消化杂志,2016,24(22):3422-3427.
[11] BIALEK S R,REDD J T,LYNCH A,et al.Chronic liver disease among two American Indian patient populations in the southwestern United States,2000-2003[J].J Clin Gastroenterol,2008,42:949-954.
[12] 王秀珍,刘雪峰.2041例肝硬化病因及并发症分析[J].浙江医学,2017,39(1):37-39.
[13] 高潇雪,刘立新.酒精性肝病流行病学及发病机制研究进展[J].中华消化病与影像杂志:电子版,2016,6(2):62-65.
[14] 周广玉,吴海静.肝硬化合并上消化道出血患者行系统性护理干预对其疗效的影响[J].现代消化及介入诊疗,2016,21(2):352-354.
[15] 王永栋,刘建茹,王莹,等.奥曲肽和普萘洛尔治疗肝硬化上消化道出血对疗效及血流动力学的影响[J].河北医药,2016,34(5):706-708.
[16] 赵铭,丁顺斌,江小云,等.复方甘草酸苷联合还原型谷胱甘肽治疗酒精性肝硬化43例临床疗效分析[J].标记免疫分析与临床,2016,23(1):38-41.
[17] 吴洪秋,张永良,黄坚尧,等.乙肝血清学标志物定量和HBV DNA定量联合检测在乙肝病毒感染诊断中的应用[J].胃肠病学和肝病学杂志,2016,25(4):415-418.