177例急性乙型肝炎流行病学及临床特征分析  

Analysis of epidemiological and clinical characteristics of 177 patients with acute hepatitis B

作　　者：付成涛[1] 刘佳[1] 陈晓红[1] 

机构地区：[1]哈尔滨医科大学附属第一医院感染科,黑龙江哈尔滨150001

出　　处：《胃肠病学和肝病学杂志》2011年第12期1130-1133,共4页Chinese Journal of Gastroenterology and Hepatology

基　　金：黑龙江省教育厅基金资助(11551301)

摘　　要：目的探讨近年来急性乙型肝炎的流行病学及临床特点,为更好地诊断、治疗及预防急性乙型肝炎提供依据。方法回顾性分析哈尔滨医科大学附属第一医院2005年1月～2011年2月确诊的177例急性乙型肝炎患者的临床资料。结果急性乙型肝炎发病以男性多见,高发年龄段为20～49岁,以工人和农民为主,多数患者传播途径不详,发病无明显季节性;起病急,76.84%为黄疸型,大多数患者出现乏力和消化道症状,部分患者出现低到中度发热,少数患者出现皮疹、关节痛,个别患者出现肾功能衰竭等罕见的肝外损害表现;绝大多数急性乙型肝炎患者能得到及时正确的诊断,个别患者曾被误诊为慢性乙型肝炎、发热原因待查、糖尿病酮症及多发性肌炎等;急性乙型肝炎预后较好,临床治愈好转率较高达93.78%,5.08%的患者进展为暴发性肝炎,半年内随访92.44%的患者HBsAg阴转,95.80%的患者HBV DNA阴转,7.56%患者转变为慢性乙型肝炎;3例口服核苷类似物抗病毒治疗的暴发性肝炎患者病情均出现了好转,4例未抗病毒治疗者死亡3例,放弃治疗2例。结论急性乙型肝炎的发病年龄及传播途径发生了明显的变化;个别患者出现了罕见的肝外损害表现;少部分患者存在误诊现象,临床医师应加强对本病的认识以减少误诊;急性乙型肝炎的预后较好,但仍有部分会发生慢性化,少部分进展为暴发型肝炎,甚至死亡;重型肝炎或有重症倾向的患者应及时使用核苷类似物抗病毒治疗。vide basis for cute hepatitis Objective To investigate the clinical and epidemiological characteristics of acute hepatitis B, and pro- better diagnosis, treatment and prevention of acute hepatitis B. Methods The clinical materials of 177 a- B patients hospitalized in the Fist Affiliated Hospital of Harbin Medical University from Jan. 2005 to Feb2011 were analyzed retrospectively. Results Acute hepatitis B occurred mostly in male, worker and farmer, aging from 20 to 49 years old without significant seasonal incidence. The main route of transmission remained unknown. Acute hep- atitis B was characterized by abrupt onset, 76.84 % of which with jaundice. Fatigue and symptom of digestive tract ap- peared in majority of patients, mild and moderate fever appeared in part of patients, rash and arthralgia appeared in few patients, and unusal extrahepatic manifestations appeared in individual patient, such as renal failure. The vast majority of acute hepatitis B patients could be diagnosed correctly, individual patients were misdiagnosed as chronic hepatitis B,fever of unknown causation, diabetic ketosis and polymyositis. 93.78% of the patients healed or improved, 5.08 % of them developed fulminant hepatitis, and 7.56% of them turned to chronic hepatitis B. There were 92.44% HBsAg con- version, and 95.80% HBV DNA conversion patients in half a year follow up. For fulminant hepatitis,3 cases were im-proved by antiviral therapy of nucleoside, while 3 cases without receiving nucleoside died and 2 cases gave up therapy. Conclusion The age of morbidity and the route of transmission have changed greatly in acute hepatitis B, and a few pa- tients developed rare extrahepatic manifestations. A small number of patients were misdiagnosed. Most of acute hepatitis B prognosis were good, only few of them turned into chronic hepatitis B, and a small number of them developed fulmi- nant hepatitis and even death.

关 键 词：急性乙型肝炎 流行病学 临床特征 

分 类 号：R512.62[医药卫生—内科学]