散发性戊型肝炎的流行病学及临床特征分析  

Analysis on epidemiological and clinical characteristics of 186 sporadic hepatits E cases

作　　者：陈吐芬 张波 张艳 万美平 郑宁 CHEN Tu-fen;ZHANG Bo;ZHANG Yan;WAN Mei-ping;ZHENG Ning(Department of Infectious Diseases,Central Theater General Hospital of Chinese People’s Liberation Army,Wuhan 430070,China)

机构地区：[1]解放军中部战区总医院感染科,武汉430070

出　　处：《肝脏》2022年第3期296-301,共6页Chinese Hepatology

摘　　要：目的探讨散发性戊型肝炎的流行病学特点、临床特征及预后。方法回顾性分析186例散发性戊型病毒性肝炎患者的临床资料,按照年龄分为老年组(≥60岁)与非老年组(<60岁),按照病原学分为重叠感染组与单纯感染组,比较各组之间的临床特点、实验室检查及治疗转归情况。结果按年龄分组中,老年组的治疗前TBil、Cr水平、TBil峰值、INR峰值、Cr峰值、皮肤瘙痒发生率、并发症(尤其泌尿系感染、自发性腹膜炎、低蛋白血症、肝性脑病)发生率、合并症发生率、住院时间、病程均高于非老年组(P<0.05),而治疗前ALT、Alb水平、ALT峰值、Alb谷值、发热发生率均低于非老年组(P<0.05),且非老年组治疗后AKP、PT、INR降低更为明显(P<0.05),而两组患者肝衰竭发生率、治愈好转率、病死率等比较差异均无统计学意义(P>0.05)。按病原学分组中,重叠组的治疗前TBil、PT、INR水平、并发症(尤其自发性腹膜炎)发生率、慢加急性肝衰竭发生率均高于单纯组(P<0.05),且单纯组治疗后PT降低更为明显(P<0.05),而两组患者临床症状、合并症发生率、治愈好转率、病死率、住院时间、病程等比较差异无统计学意义(P>0.05)。结论重叠组与老年组患者更易出现高胆红素血症、低蛋白血症及凝血功能异常,更易引起肝衰竭,并发症多见,住院时间延长,预后较差,提示年龄和重叠感染是影响患者预后的主要因素。Objective To investigate the epidemiological characteristics,clinical features and prognosis of sporadic hepatitis E(HE).Methods The clinical data of 186 patients with sporadic HE were retrospectively analyzed.According to age,all the patients were divided into elderly group(≥60 years old)and non-elderly group(<60 years old).According to etiology,they were divided into super infection group and simple infection group.The clinical characteristics,laboratory examination and treatment outcome were compared between each group.Results Before treatment,the total bilirubin(TBiL)level,creatinine(Cr)level,TBiL peak value,international normalized ratio(INR)peak value,Cr peak value,incidence of skin pruritus,incidence of complications(especially urinary tract infection,spontaneous peritonitis,hypoproteinemia,hepatic encephalopathy),incidence of combined diseases,length of hospital stay and course of disease of elderly group were higher than those of non-elderly group(P<0.05).While the levels of alanine transaminase(ALT)albumin(ALB),ALT peak,ALB valley,and the incidence of fever of elderly group were lower than those of non-elderly group(P<0.05).After treatment,the levels of alkline phosphatase(AKP),and HYPERLINK"http://www.youdao.com/w/prothrombin time/"/l"keyfrom=E2Ctranslation"prothrombin time(PT)in non-elderly group decreased more significantly(P<0.05).And there was no significant difference in the incidence rate of liver failure,cure improvement and mortality between the 2 groups(P>0.05).Before treatment,the TBiL level,PT,INR,incidence of complications(especially spontaneous peritonitis)and incidence of acute on chronic liver failure of super infection group were higher than those of simple infection group(P<0.05).After treatment,PT of simple infection group decreased more obviously than super infection group(P<0.05),while there was no significant difference in clinical symptoms,complications rate,cure improvement rate,mortality,length of hospital stay and course of disease between the 2 groups(P>0.05).Conclusion Pati

关 键 词：戊型肝炎 散发性 肝衰竭 临床特征 流行病学 预后 

分 类 号：R47[医药卫生—护理学]