散发性急性黄疸型甲、戊型肝炎335例临床分析  

Clinical analysis of clinical feature of sporadic acute icteric hepatitis A and hepatitis E: A report of 335 cases

作　　者：朱鹏[1] 朱季香[2] 何登明[1] 徐城[1] 郭世民[1] 李茂仕[1] 王宇明[1] 

机构地区：[1]第三军医大学西南医院全军感染病研究所,重庆400038 [2]遂宁市第一人民医院消化内科,四川遂宁629000

出　　处：《解放军医学杂志》2014年第9期725-730,共6页Medical Journal of Chinese People's Liberation Army

基　　金：国家"十二五"科技重大专项(2012ZX10002004);国家自然科学基金面上项目(81270536)~~

摘　　要：目的分析急性黄疸型甲型、戊型肝炎患者的临床特征,探讨在不同肝脏病变基础上两类患者病情的异同,并对影响二者临床转归的危险/暴露因素进行归因分析。方法回顾性分析335例在第三军医大学西南医院全军感染病研究所入院诊断为急性黄疸型甲型肝炎（HA组,n=100）、急性黄疸型戊型肝炎（HE组,n=235）患者的临床特征,包括年龄、性别、发病季节、前驱症状及生化指标等。根据肝纤维化程度（APRI指数）、有无慢性HBV感染及有无肝硬化基础对两组患者进行分层分析,对影响疾病转归的危险/暴露因素进行logistic回归分析。结果 HE组患病年龄（43.8±15.4岁）高于HA组（32.0±13.0岁,P〈0.001）,两组患者皆以男性多见,HE组男女比例高于HA组（P〈0.001）,均以2～4月份为多发时段。两组常见临床症状相似,但HE组总胆红素（Tbil）水平较高（P〈0.05）,而发热、恶心呕吐比例较低（P〈0.001）。代偿期肝硬化患者重叠HA或HE后,较无肝硬化基础组Tbil升高,PTA、ALB降低,ALT及Tbil恢复时间延长,发生肝功能失代偿及并发症的比例增高,病死率增加（P〈0.05）。随患者基础肝纤维化程度增加,重叠HAV或HEV感染后肝脏损害加重（P〈0.05）。长期饮酒、高龄及慢性HBV感染是肝硬化重叠HE出现重症化的危险因素。结论急性黄疸型HA与HE临床特征大致相似,但发病年龄、黄疸程度存在差异。重叠HA或HE时可加重肝功能损害,其程度与肝脏基础病变相关。高龄、HBV感染及饮酒等因素可加重肝硬化合并HA或HE感染时的肝功能失代偿。Objective To investigate the clinical feature and outcome of patients with pre-existing chronic liver disease were co-infected with acute icteric hepatitis A or E. Methods 335 patients diagnosed with acute icteric hepatitis in Southwest Hospital were divided into hepatitis A （HA） group （n=100） and hepatitis E （HE） group （n=235）. The clinical features （age, gender, season distribution, prodromal symptom） and laboratory data were analyzed retrospectively. The stratification analysis was performed in the two groups according to the degree of hepatic fibrosis （APRI ratio index）, HBV infection and cirrhosis status. The risk factors affecting the outcome were analyzed by logistic regression analysis. Results The mean age of patients of HE group （43.8 ± 15.4） was older than that of HA group （32.0 ±13.0, P=8.045 × 10^-11）. Male patients were predominant in the two groups, and male/female ratio was higher in HE group （P=2.139 × 10^4）. High prevalence was found within the period of February to April. Except for a higher total bilirubin （Tbil） level （P〈0.05） and lower incidence of fever, nausea and vomiting （P〈0.05） in HE group, there was no difference in other clinical manifestations between the two groups. Compared with those without cirrhotic, cirrhosis patients co-infected with HA or HE showed an increased Tbil, decreased PTA and Alb, prolonged ALT and Tbil recovery time, higher incidence of hepatic decompensation and related complications, and higher mortality （P〈0.05）. Liver iniury was more marked in patients with chronic liver disease who were infected with HAV or HEV with exacerbation of previous liver fibrosis.Alcohol consumption, age and chronic HBV infection were risk factors for liver decompensation in patients with cirrhosis associated with HE. Conclusion Sporadic acute icteric HA and HE showed similar clinical features, but different in age distribution and jaundice index. Its coexistence with HA or HE can cause severe liver decompensation, the degr

关 键 词：甲型 肝炎 戊型 黄疸 肝硬化 

分 类 号：R512.61[医药卫生—内科学] R512.65[医药卫生—临床医学]