急性戊型肝炎严重黄疸患者的临床特征及危险因素分析  

Clinical features and risk factors of acute hepatitis E with severe jaundice

作　　者：刘玉 梅雪[1] 张宇一[1] 邹颖[1] 张正国[1] 郭红英[1] 袁伟[1] 王介非[1] 钱志平[1] LIU Yu;MEI Xue;ZHANG Yuyi;ZOU Ying;ZHANG Zhengguo;GUO Hongying;YUAN Wei;WANG Jiefei;QIAN Zhiping(Shanghai Public Health Clinical Center Affiliated to Fudan University, Shanghai 201508, China)

机构地区：[1]上海市(复旦大学附属)公共卫生临床中心,上海201508

出　　处：《临床肝胆病杂志》2021年第3期565-569,共5页Journal of Clinical Hepatology

基　　金：国家“十三五”科技重大专项(2018ZX10725506-002);2018年院级科研课题(KY-GW-2018-23)。

摘　　要：目的分析伴或不伴严重黄疸的急性戊型肝炎患者的临床特征,并探究发生严重黄疸的危险因素。方法回顾性分析2018年1月1日—2020年3月26日上海市公共卫生临床中心收治的179例急性戊型肝炎患者的临床资料。根据TBil是否>171μmol/L分为AHE伴轻度黄疸(AHE-M)组和AHE伴严重黄疸(AHE-S)组,比较两组临床资料及实验室检查指标。两组间比较采用t检验、Mann-Whitney U检验或χ2检验,独立危险因素分析采用二元logistic回归。结果179例患者56.42%(101例)伴严重黄疸。与AHE-M组比较,AHE-S组男性占比多(80.20%vs 61.54%,χ2=7.612,P=0.006),住院时间长[29(19~45)d vs 18(14~22)d,Z=-6.035,P<0.001],发生肝衰竭的人数多[23 vs 0,χ2=18.373,P<0.001],预后差(P<0.001)。AHE-S组基线的抗-HEV-IgM、AFP、肝脏弹性值均高于AHE-M组(Z值分别为-3.534、-3.588、-4.496,P值均<0.001),基线的CD4低于AHE-M组(Z=-2.015,P<0.05),TBil、DBil、肌酐、凝血酶原时间、INR、中性粒细胞绝对数的峰值均高于AHE-M组(Z值分别为-11.016、-10.926、-2.726、-4.787、-4.989、-6.016,P值均<0.01),GGT的峰值、白蛋白、前白蛋白、淋巴细胞绝对数的谷值均低于AHE-M组(Z值分别为-4.550、-4.685、-5.087、-4.818,P值均<0.001)。logistic回归分析显示抗-HEV-IgM(OR=1.022,95%CI:1.005~1.039,P=0.012)、GGT(OR=0.995,95%CI:0.993~0.998,P=0.001)、前白蛋白(OR=0.991,95%CI:0.983~0.999,P=0.02)、中性粒细胞(OR=1.486,95%CI:1.169~1.889,P=0.001)是急性戊型肝炎患者出现严重黄疸的独立危险因素。结论急性戊型肝炎严重黄疸患者男性占比多,住院时间长,发生肝衰竭人数多,预后差,抗-HEV-IgM、GGT、前白蛋白、中性粒细胞是急性戊型肝炎患者出现严重黄疸的独立危险因素。Objective To investigate the clinical features of acute hepatitis E(AHE)patients with or without severe jaundice and the risk factors for severe jaundice.Methods A retrospective analysis was performed for the clinical data of 179 AHE patients who were admitted to Shanghai Public Health Clinical Center Affiliated to Fudan University from January 1,2018 to March 26,2020.According to whether total bilirubin(TBil)was>171μmol/L,the patients were divided into AHE-mild jaundice(AHE-M)group and AHE-severe jaundice(AHE-S)group,and the two groups were compared in terms of clinical data and laboratory markers.The t test or the Mann-Whitney U test or the chi-squared test was used for comparison,and a binary logistic regression analysis was used to identify independent risk factors.Results Of all 179 patients,101(56.42%)were found to have severe jaundice.Compared with the AHE-M group,the AHE-S group had a significantly higher proportion of male patients(80.20%vs 61.54%,χ2=7.612,P=0.006),a significantly longer length of hospital stay[29(19-45)days vs 18(14-22)days,Z=-6.035,P<0.001],a significantly higher number of patients with liver failure(23 vs 0,χ2=18.373,P<0.001),and a significantly poorer prognosis(P<0.001).Compared with the AHE-M group,the AHE-S group had significantly higher baseline anti-HEV-IgM,alpha-fetoprotein,and liver elasticity(Z=-3.534,-3.588,and-4.496,all P<0.001),significantly lower baseline CD4(Z=-2.015,P<0.05),significantly higher peak values of TBil,direct bilirubin,creatinine,prothrombin time,international normalized ratio,and absolute neutrophil count(Z=-11.016,-10.926,-2.726,-4.787,-4.989,and-6.016,all P<0.01),a significantly lower peak value of gamma-glutamyl transpeptidase(GGT)(Z=-4.55,P<0.001),and significantly lower valley values of albumin,prealbumin(PA),and absolute lymphocyte count(Z=-4.685,-5.087,and-4.818,all P<0.001).The logistic regression analysis showed that anti-HEV-IgM(odds ratio[OR]=1.022,95%confidence interval[CI]:1.005-1.039,P=0.012),GGT(OR=0.995,95%CI:0.993-0.998,P=0.001),PA(OR=0.9

关 键 词：戊型肝炎 黄疸 危险因素 

分 类 号：R512.6[医药卫生—内科学]