住院慢性乙型肝炎病毒感染者肝病谱构成比的变化分析  

Analysis of the Changes of the Disease Spectrum of Patients with ChronicHepatitis B Virus Infection

作　　者：时红[1] 陈幼明[1] 郑丽花[1] 曹静 崇雨田[1] 揭育胜[1] SHI Hong;CHEN You-ming;ZHENG Li-hua;CAO Jing;CHONG Yu-tian;JIE Yu-sheng(Department of Infectious Diseases,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院感染科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2020年第6期910-916,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广州市科技计划项目(201804010474);中山大学高校基本科研业务费专项基金(20ykpy24)。

摘　　要：【目的】探讨抗病毒治疗以及治疗依从性对住院慢性乙型肝炎病毒(HBV)感染者肝病谱构成比的影响。【方法】回顾性收集2018年在中山大学附属第三医院感染科住院的慢性HBV感染者。根据患者入院前既往抗病毒治疗史,将纳入的患者分为抗病毒组(n=460)和未抗病毒组(n=1240);根据患者的治疗依从性将抗病毒治疗的患者分为规范抗病毒组(n=277)和不规范抗病毒组(n=183)。分别比较两组的肝病谱构成比的分布情况。并与2011年的研究结果进行比较。【结果】入院时抗病毒组中诊断为慢性乙型肝炎(CHB;中度)、CHB(重度)、慢加急性肝衰竭、肝硬化(代偿期)的比例显著低于未抗病毒组,差异有统计学意义(P<0.01);而诊断为肝硬化(失代偿期)的患者比例高于未抗病毒组(70%vs.37.1%,P<0.001)。诊断CHB(中度)、CHB(重度)、慢加急性肝衰竭的比例在规范抗病毒组显著高于不规范抗病毒组,差异有统计学意义(P<0.01),而规范抗病毒组的肝硬化(失代偿期)患者比例显著高于不规范抗病毒组,差异均有统计学意义(P<0.001)。2011年与2018年住院患者肝病谱构成比差异有统计学意义(P<0.001)。相比2011年,2018年诊断CHB(中度)、CHB(重度)的患者比例有所下降(P<0.05),而慢加急性肝衰竭的比例显著增高(11.8%vs.16.9%,P<0.001)。合并肝细胞癌的住院患者比例在2018年显著高于2011年(19.5%vs.10.5%,P<0.001)。2018年住院患者此前接受抗病毒的比例高于2011年住院患者(27.1%vs.17.2%,P<0.001),不规范抗病毒的患者比例也显著高于2011年(P=0.003)。【结论】抗病毒治疗可减少CHB患者因肝炎活动而住院的比例,但不规范的抗病毒治疗增加了CHB(重度)、慢加急性肝衰竭患者的构成比。合并诊断原发性肝细胞癌的患者有增加趋势。【Objective】To explore the effect of antiviral treatment and treatment adherence on the disease spectrum of patients with chronic hepatitis B virus(HBV)infection.【Methods】Data of patients with chronic HBV infection treated in the Department of Infectious Diseases of the Third Affiliated Hospital of Sun Yat-sen University in 2018 were retrospec⁃tively collected.According to the antiviral treatment history,the patients were divided into antiviral group(n=460)and non-antiviral group(n=1240);according to the treatment adherence,the patients were divided into standard antiviral group(n=277)and non-standard antiviral group(n=183).The distribution of disease spectrum was compared between these two groups.Meanwhile,the differences of the proportion of disease spectrum were compared with previous data in 2011.【Results】The proportion of patients diagnosed as chronic hepatitis B(CHB)(moderate),CHB(severe),acute-onchronic liver failure(ACLF)and cirrhosis(compensated stage)in antiviral group was significantly lower than that in nonantiviralgroup(P<0.01),while the proportion of patients diagnosed as cirrhosis(decompensated stage)was higherthan that in non-antiviral group(70%vs.37.1%,P<0.001).The proportion of CHB(moderate),CHB(severe)and ACLFin the standard antiviral group was significantly lower than that in the non-standard antiviral group(P<0.01),and theproportion of patients diagnosed as cirrhosis(decompensated stage)in the standard antiviral group was significantly higherthan that in the non-standard antiviral group(P<0.001).There was a significant difference between the data of 2011and those of 2018(P<0.001).Compared with that in 2011,the proportion of patients diagnosed with CHB(moderate)and CHB(severe)decreased in 2018(P<0.05),while the proportion of ACLF increased significantly(11.8%vs.16.9%,P<0.001).The proportion of hospitalized patients with hepatocellular carcinoma was significantly higher in 2018 than in2011(19.5%vs.10.5%,P<0.001).In 2018,the proportion of inpatients who have received antiviral thera

关 键 词：抗病毒治疗 乙型肝炎病毒 肝病谱 

分 类 号：R51[医药卫生—内科学]