血吸虫性肝病合并戊型肝炎老年患者36例临床分析  

Clinical Analysis of 36 Elderly Patients with Schistosome-Induced Liver Disease Complicated by Hepatitis E

作　　者：余晓[1] 邓敏[1] 张戡[1] 谢新生[1] 

机构地区：[1]嘉兴市第一医院感染科,嘉兴314000

出　　处：《中国寄生虫学与寄生虫病杂志》2015年第4期258-260,263,共4页Chinese Journal of Parasitology and Parasitic Diseases

摘　　要：目的探讨老年血吸虫性肝病合并戊型肝炎老年患者的临床特点。方法将嘉兴市第一医院36例血吸虫性肝病合并戊型肝炎老年患者(观察组)与38例单纯戊型肝炎老年患者(对照组)的血常规、肝功能、凝血功能和肝纤维化血清学指标检测结果,及B超测量肝门静脉内径和脾门区脾静脉内径的结果,结合其临床表现、病程和转归情况等进行分析。结果 74例老年戊型肝炎均为急性起病。血吸虫性肝病合并感染戊型肝炎患者,病情重,易重症化。观察组患者恶心(91.7%,33/36)、呕吐(88.9%,32/36)及皮肤瘙痒(33.3%,12/36)等症状的发生率较对照组患者高(P<0.05)。入院时观察组的平均总胆红素(TBIL)和丙氨酸转氨酶(ALT)水平分别为(153.22±29.71)μmol/L和(705.14±356.55)U/L均显著高于对照组[分别为(109.89±26.28)μmol/L和(485.74±297.49)U/L](P<0.01或P<0.05),而白蛋白(ALB)、凝血酶原活动度(PTA)、血白细胞、血红蛋白和血小板则均显著低于对照组(P<0.01)。观察组的4个肝纤维化血清学指标,即透明质酸(HA)、层黏连蛋白(LN)、血清Ⅲ型前胶原肽(PⅢ)和Ⅳ型胶原(Ⅳ-C)均显著高于对照组(P<0.01)。此外,在B超下测量观察组患者的肝门静脉内径和脾门区脾静脉内径,分别为(16.56±3.38)mm和(10.28±3.31)mm,均显著大于对照组[分别为(14.82±3.48)mm和(8.26±3.27)mm](P<0.01)。观察组患者的肝功能恢复慢,住院时间[(43.7±7.1)d]较对照组[(29.5±5.1)d]显著延长(P<0.01)。结论血吸虫性肝病合并戊型肝炎的老年患者肝脏损害较单纯戊型肝炎老年患者严重,需加强监护与治疗。Objective To explore the clinical characteristics of schistosome-induced liver disease complicated by hepatitis E in elderly patients. Methods Thirty-six senile patients with schistosome-induced liver disease complicated by hepatitis E（the observation group） and 38 senile patients with simple hepatitis E（the control group） were from the First Hospital of Jiaxing City. The blood routine measurements, indicators of liver function and blood coagulation function, serum markers of liver fibrosis, and B-ultrasonic measurements of hepatic portal vein diameter and spleen hilus inside diameter of splenic vein, were analyzed in combination with clinical manifestations, disease course and outcomes. Results All the 74 cases had acute onset of hepatitis E. The patients in the observation group had severer conditions, which were prone for aggravation. In this group, the incidences of nausea（91.7%, 33/36）, vomit（88.9%, 32/36） and pruritus（33.3%, 12/36） were all higher than those in the control group（P〈0.05）. The levels of average total bilirubin and alanine aminotransferase at admission were （153.22±29.71） mol/L and （705.14±356.55） U/L respectively, in the observation group, significantly higher than those in the control group[（109.89±26.28） mol/L and （485.74±297.49） U/L]（P〈0.01）. In contrast, the levels of albumin, prothrombin activity, white blood cell, hemoglobin and platelet at admission were significantly lower in the observation group than in the control（P〈0.01）. In addition, the levels of four serum markers of liver fibrosis, i.e, the transparent hyaluronic acid, laminin, type III serum procollagen peptide and type IV collagen, were all significantly higher in the observation group than in the control（P〈0.01）. Further, B-ultrasonic measurements of hepatic portal vein diameter and spleen hilus inside diameter of splenic vein in the observation group were （16.56±3.38） mm and （10.28±3.31） mm, significantly higher than those in the control[（14.8

关 键 词：血吸虫性肝病 戊型肝炎 老年 临床分析 

分 类 号：R532.21[医药卫生—内科学]