肝硬化的病因及防治现状调查  

Investigate of the etiology and prevention status of liver cirrhosis

作　　者：戴二黑 郭心如 王继涛[3] 胡庆刚 李加欢 唐奇远[6] 祖红梅 宦徽 王岩[9] 郜玉峰[4] 胡国启 李卫 刘贞君[12] 马前坡 宋有良[14] 杨江华[15] 朱艳 黄顺东[17] 孟忠吉[18] 白冰 陈友鹏 高畅 黄明星[21] 金少琴[22] 鲁萌芝 许哲[24] 张倩华 郑双 曾庆磊[27] 祁小龙 Dai Erhei;Guo Xinru;Wang Jitao;Hu Qinggang;Li Jiahuan;Tang Qiyuan;Zu Hongmei;Huan Hui;Wang Yan;Gao Yufeng;Hu Guoqi;Li Wei;Liu Zhenjun;Ma Qianpo;Song Youliang;Yang Jianghua;Zhu Yan;Huang Shundong;Meng Zhongji;Bai Bing;Chen Youpeng;Gao Chang;Huang Mingxing;Jin Shaoqin;Lu Mengzhi;Xu Zhe;Zhang Qianhua;Zheng Shuang;Zeng Qinglei;Qi Xiaolong(Division of Liver Disease,the Fifth Hospital of Shijiazhuang,North China University of Science and Technology,Shijiazhuang 050021,China;School of Public Health,North China University of Science and Technology,Tangshan 063210,China;CHESS Center,Xingtai People′s Hospital,Xingtai 054001,China;Department of Infectious Diseases,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Infectious Diseases,Union Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Second Department of Hepatology,Shenzhen Third People′s Hospital,Shenzhen 518112,China;Department of Gastroenterology,Fourth People′s Hospital of Qinghai Province,Xining 810007,China;Department of Gastroenterology,Hospital of Chengdu Office of Tibet Autonomous Region People′s Government,Chengdu 610041,China;Working Group of CHESS Frontier Center,Shenyang Sixth People′s Hospital,Shenyang 110006,China;Department of Infectious Diseases,People′s Hospital of Jieshou,Jieshou 236502,China;the Third Department of Infection,the Second People′s Hospital of Fuyang City,Fuyang 236029,China;Department of Infectious Diseases,Anqing Municipal Hospital,Anqing 246004,China;Department of Infectious Diseases,People′s Hospital of Linquan County,Anhui Province,Linquan 236499,China;Department of Infectious Diseases,Tongling People′s Hospital,Tongling 244099,China;Department of Infectious Diseases,Yijishan Hospital,the First Affiliated to Wannan Medical College,Wuhu 241006,China;Department of Infectious Diseases,Chizhou People′s Hospital,Chizhou 247099,China;Department of Infectious Diseases,the Second People′s Hospital of Jingzhou City,Jing

机构地区：[1]华北理工大学附属石家庄市第五医院肝病部,石家庄050021 [2]华北理工大学公共卫生学院,唐山063210 [3]邢台市人民医院门脉高压研究中心,邢台054001 [4]安徽医科大学第一附属医院感染科,合肥230022 [5]华中科技大学同济医学院附属协和医院感染科,武汉430022 [6]深圳市第三人民医院肝病二科,深圳518112 [7]青海省第四人民医院消化科,西宁810007 [8]西藏自治区人民政府驻成都办事处医院消化内科,成都610041 [9]沈阳市第六人民医院CHESS前沿中心工作小组,沈阳110006 [10]安徽省界首市人民医院感染科,界首236502 [11]安徽省阜阳市第二人民医院感染三科,阜阳236029 [12]安徽省安庆市立医院感染性疾病科,安庆246004 [13]安徽省临泉县人民医院感染科,临泉236499 [14]安徽省铜陵市人民医院感染疾病科,铜陵244099 [15]安徽省皖南医学院第一附属弋矶山医院感染性疾病科,芜湖241006 [16]安徽省池州市人民医院感染科,池州247099 [17]湖北省荆州市第二人民医院感染科,荆州434002 [18]湖北省十堰市太和医院感染科,十堰442099 [19]华中科技大学协和深圳医院感染科,深圳518052 [20]中山大学附属第七医院感染性疾病科,深圳518107 [21]中山大学附属第五医院感染科,珠海519000 [22]南方医科大学珠江医院消化内科,广州510280 [23]深圳市龙岗中心医院感染科,深圳518116 [24]广东省东莞市人民医院消化内科,东莞523058 [25]广东省中山市第二人民医院肝病科,中山528447 [26]沈阳市第六人民医院腔镜科,沈阳110006 [27]郑州大学第一附属医院感染病科,郑州450052 [28]东南大学附属中大医院门静脉高压中心,南京210009

出　　处：《中华医学杂志》2023年第12期913-919,共7页National Medical Journal of China

摘　　要：目的调查我国肝硬化患者的病因、防治现状、地区差异,为我国肝硬化的诊疗措施制定和防治水平提高提供科学依据。方法本项横断面研究分析了2018年1月1日至2020年12月31日我国七大地理分区的50家医院首次住院诊断为肝硬化的患者临床资料,分析患者病因构成、治疗方案及其在不同区域的差异。结果区域分布方面,研究共纳入11861例肝硬化患者。疾病严重程度方面,代偿期患者5093例(42.94%),失代偿期患者6768例(57.06%)。病因方面,慢性乙型肝炎8439例(71.15%)、酒精性肝病1337例(11.27%)、慢性丙型肝炎963例(8.12%)、自身免疫性肝病698例(5.88%)、血吸虫性肝病367例(3.09%)、非酒精性脂肪性肝病177例(1.49%)以及其他类型肝病743例(6.26%)。病因分布差异方面,慢性乙型肝炎、慢性丙型肝炎、酒精性肝病、非酒精性脂肪性肝病、血吸虫性肝病、自身免疫性肝病的区域分布差异均有统计学意义(P<0.001)。手术治疗方面,1139例(9.60%)患者接受了内镜治疗,718例(6.05%)接受了外科治疗,456例(3.84%)接受了介入治疗。内科治疗方面,在代偿期患者中,有60例(0.51%)接受了非选择性β受体阻滞剂(NSBB)治疗,其中接受普萘洛尔治疗59例(0.50%)、接受卡维地洛治疗1例(0.01%);在失代偿期患者中,有310例(2.61%)接受了NSBB治疗,其中接受普萘洛尔治疗303例(2.55%)、接受卡维地洛治疗7例(0.06%)。内外科治疗的区域差异方面,不同地区患者接受内镜治疗、介入治疗、NSBB治疗等的差异有统计学意义(P<0.001)。结论我国现阶段大部分地区肝硬化病因仍以慢性乙型肝炎为主,酒精性肝病成为第二大病因。肝硬化的三级防控在我国仍待加强。Objective To investigate the etiology,prevention and treatment status,and their corresponding regional differences of the patients with liver cirrhosis in China,in order to provide scientific basis for the development of diagnosis and control strategies in China.Methods Clinical data of patients diagnosed with liver cirrhosis for the first time through January 1,2018 to December 31,2020 from 50 hospitals in seven different regions of China were collected and analyzed retrospectively,and the difference of etiology,treatment,and their differences in various regions were analyzed.Results A total of 11861 cases with liver cirrhosis were included in the study.Thereinto,5093 cases(42.94%)were diagnosed as compensated cirrhosis,and 6768 cases(57.06%)had decompensated cirrhosis.Notably,8439 cases(71.15%)were determined as chronic hepatitis B-caused cirrhosis,1337 cases(11.27%)were alcoholic liver disease,963 cases(8.12%)were chronic hepatitis C,698 cases(5.88%)were autoimmune liver disease,367 cases(3.09%)were schistosomiasis,177 cases(1.49%)were nonalcoholic fatty liver,and 743 cases(6.26%)of other types of liver disease.There were significant differences in the incidence of chronic hepatitis B,chronic hepatitis C,alcoholic liver disease,fatty liver,schistosomiasis liver disease,and autoimmune liver disease among the seven regions(P<0.001).Only 1139 cases(9.60%)underwent endoscopic therapy,thereinto,718 cases(6.05%)underwent surgical therapy,and 456 cases(3.84%)underwent interventional therapy treatment.In patients with compensated liver cirrhosis,60 cases(0.51%)underwent non-selectiveβreceptor blockers(NSBB),including 59 cases(0.50%)underwent propranolol and 1 case(0.01%)underwent carvedilol treatment.In patients with decompensated liver cirrhosis,310 cases(2.61%)underwent NSBB treatment,including 303 cases(2.55%)underwent propranolol treatment and 7 cases(0.06%)underwent carvedilol treatment.Interestingly,there were significant differences in receiving endoscopic therapy,interventional therapy,NSBB therapy,splenectom

关 键 词：肝硬化 中国 分布 病因 防控 治疗 

分 类 号：R575.2[医药卫生—消化系统]