HBV感染合并酒精性肝病的失代偿期肝硬化患者的临床特征及预后  

Clinical characteristics and prognosis of decompensated cirrhotic patients with hepatitis B virus infection and alcoholic liver disease

作　　者：张国顺 刘斌 方正亚 孟冬梅 

机构地区：[1]华北理工大学附属医院消化内科,河北省唐山市063000

出　　处：《世界华人消化杂志》2016年第22期3422-3427,共6页World Chinese Journal of Digestology

摘　　要：目的:探讨乙型肝炎病毒(hepatitis B virus,HBV)感染合并酒精性肝病(alcoholic liver disease,ALD)失代偿期肝硬化患者的临床特点,评价HBV感染与酒精性肝病之间的关系,分析其预后,为临床治疗提供参考.方法:采用病例对照研究,严格按照病例和对照的纳入和排除标准,选取2010-01/2015-10在华北理工大学附属医院住院的HBV感染合并ALD的肝硬化失代偿期患者86例作为观察组,选择同期住院的单纯HBV感染肝硬化失代偿期患者94例(乙型肝炎组)、单纯ALD的失代偿期肝硬化患者92例(酒精肝组)作为对照组.对3组患者的临床资料和实验室结果进行回顾性分析,评价3组的治疗效果,分析HBV感染与ALD之间的关系.结果:观察组在乏力、腹胀、食欲不振、黄疸等常见临床表现较乙型肝炎组、酒精肝组相比(P>0.05),差异没有统计学意义,在上消化道出血、肝性脑病、腹水并发症方面差异具有统计学意义(P<0.01);3组患者肝功能指标谷丙转氨酶、谷草转氨酶、胆碱脂酶、总胆红素均有不同程度的异常,且观察组较乙型肝炎组、酒精肝组相比明显加重,差异具有统计学意义(P<0.05);3组患者病理指标,观察组炎症程度较乙型肝炎组、酒精肝组相比,差异具有统计学意义(P<0.05).结论:HBV感染合并ALD对肝脏损伤具有协同作用,会加重肝功能损伤,促使病情恶化,降低治疗效果.AIM：To investigate the clinical characteristics of decompensated cirrhotic patients with HBV infection combined with alcoholic liver disease（ALD）,evaluate the relationship between HBV infection and alcoholic liver disease,and analyze the prognosis of these patients.METHODS：This was a case-control study,Liver cirrhosis patients from the Affiliated Hospital of North China University of Technology were enrolled from January 2010 to October 2015.Eighty-six liver cirrhosis patients with both HBV infection and alcoholic liver disease were selected as a study group.Ninety-four liver cirrhosis patients with HBV infection only and92 liver cirrhosis patients with ALD alone were used as controls.Clinical data and laboratory results were retrospectively analyzed to evaluate the therapeutic effect in the three groups,and to analyze the relationship between HBV infection and ALD.RESULTS：Compared to the control groups,the observation group showed no difference in abdominal distension,loss of appetite,fatigue,jaundice or other common clinical symptoms（P〉0.05）.However,upper gastrointestinal bleeding,hepatic encephalopathy,and ascites were statistically different between the study group and the control groups（P〈0.01）.ALT,AST,CHE,and TBIL had different degrees of abnormality in the three groups,which were significantly higher in the study group than in the other two groups（P〈0.05）.The degree of inflammation in the study group was more severe compared with the other two groups（P〈0.05）.CONCLUSION：HBV infection combined with ALD has a synergistic effect on liver injury,which can aggravate liver function,promote the deterioration of the disease and reduce the therapeutic effect.

关 键 词：乙型肝炎病毒感染 酒精性肝病 肝硬化 

分 类 号：R512.62[医药卫生—内科学] R575[医药卫生—临床医学]