25946例行肝穿刺检查肝病病例的临床病理、流行病学及转归的研究  

Pathological,epidemiological and prognostic studies in 25946 patients with liver disease with liver needle biopsy

作　　者：赵景民[1] 周光德[1] 孙艳玲[1] 周先志[2] 赵雨来[1] 李文淑[3] 潘登[1] 杨建法[1] 刘树红[1] 黄春[4] 张玲霞[5] 

机构地区：[1]解放军第302医院病理科,北京100039 [2]解放军第302医院感染性疾病科,北京100039 [3]解放军第302医院综合门诊,北京100039 [4]首都医科大学附属佑安医院感染疾病科 [5]解放军第302医院专家组,北京100039

出　　处：《解放军医学杂志》2008年第10期1183-1187,共5页Medical Journal of Chinese People's Liberation Army

摘　　要：目的研究1980年1月-2008年6月中国大陆肝脏疾病患者的主要疾病构成谱,临床病理学及流行病学特点,以及部分肝病患者的转归。方法采用回顾性分析与病理学和血清学实验室再检测相结合的方法,对1980年1月-2008年6月主要来自中国大陆31个省市的25 946例行肝穿刺(简称肝穿)的肝病患者(含1 448例罹患肝病的军人)进行临床、病理、实验室分析研究,并对其中的1 322例慢性乙型病毒性肝炎患者进行了为期0.5~18年动态肝穿(2~8次肝穿)随访,观察慢性乙型肝炎的转归状况。结果本组研究病例中男女比为3∶1,年龄范围41d^91岁(32.3±14.4岁),肝病分布以18~37岁为高峰,其中冀、豫、京、鲁、晋为前5位肝病病例来源地。本组病例诊断肝脏疾病谱涵盖100余种,其中感染与非感染性肝病组分别占73.05%和26.95%。该两大类肝病于2000年后均呈总体上升趋势,其中非感染性肝病升幅更为显著。本组的随访资料显示,慢性乙型肝炎是肝衰竭、肝硬化和肝癌的首位相关性肝病,丙型肝炎为肝硬化、肝癌的次位相关性肝病;0.26%的甲型肝炎和0.51%的戊型肝炎病理上存在慢性化病变;1 322例慢性乙型肝炎随访患者中,转归为肝硬化、肝癌的比例分别为15.36%(203例)和1.06%(14例),演变间隔时间分别为46.37±16.93个月和60.29±39.15个月,肝纤维化上升1个S期以上的比例占14.22%(188例),纤维化进展间隔时间为22.20±20.65个月,而肝纤维化程度下降1个S期以上和稳定病例分别占33.36%(441例)和36.01%(476例)。结论本研究基本明确了近28年间中国大陆居民的肝病疾病谱及发病状况,其中不乏疑难或少见病例。本研究阐述了中国大陆主要肝病的一般临床流行病学特点,并从临床病理角度进一步明确了中国慢性乙型肝炎的转归及演变时间。Objective To study the disease spectrum, the features of clinical pathology, epidemiology and prognosis of liver diseases in Chinese populations from Jan. 1980 to Jun. 2008. Methods Twenty-five thousand nine hundred and forty-six patients with liver disea ses in a wide spectrum of inhabitants （including 1 448 military patients） from 31 provinces or cities of all over China's Mainland in recent 28 years were involved in the present study for a retrospective study regarding their clinical, pathological and epidemiological features, including laboratory reexaminations and pathological examination. 1 322 patients with liver disease （course lasted from 6 months to 18 years） were followed up by more than 2 liver biopsies to study the outcome of chronic hepatitis 13. Results For all the patients involved, the sex ratio of male to female was 3 to 1, with mean age of 32. 3±14.4 years ranging from 41 days to 91 years, and the diseases occurred pre dominantly between the age of 18 to 37 years. Hebei, Henan, Beijing, Shandong and Shanxi provinces （city） ranked at the fore in the en demic distribution of the diseases. The spectrum of liver disease covered more than 100 kinds of liver diseases, of which 73.05~ were in fectious liver disease. As a whole, the incidence of both infectious and noninfectious, especially the non-infectious liver diseases became more prevalent since 2000. It was shown that the chror^ic hepatitis B was the most predominant factor which caused liver failure, liver cirrhosis and liver cancer, and chronic hepatitis C was the second factor. Chronic infection pathological changes were found in the liver tissues in 0. 26% patients with hepatitis A and 0. 51% patients with hepatitis E. For all the 1 322 followe＆up patients with chronic hepatitis B, the incidence of liver cirrhosis and hepatoeellular carcinoma was respectively 15.36% （203 eases） and 1.06% （14 cases）, and the average progressive period for the changes in pathology was 46.37_＋ 16. 93 months and 60. 29_＋39. 15 months,

关 键 词：肝疾病 病理学 临床 预后 流行病学 活组织检查 针吸 

分 类 号：R512.6[医药卫生—内科学]