236例急性戊型肝炎的临床特征及危险因素分析

肝脏 ›› 2017, Vol. 22 ›› Issue (6): 498-501.

236例急性戊型肝炎的临床特征及危险因素分析

史冬梅,王晓琳,项晓刚,谢青

200025 上海交通大学医学院附属瑞金医院感染科

出版日期:2017-06-30 发布日期:2017-06-30
通讯作者: 王晓琳,Email:157262879@qq.com
基金资助:
上海市公共卫生三年行动计划重点学科建设项目传染病与微生物学(15GWZK0102)

Clinical features and risk factors of 236 cases with acute hepatitis E

SHI Dong-mei, WANG Xiao-lin, XIANG Xiao-gang, XIE Qing

Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China

Online:2017-06-30 Published:2017-06-30
Contact: WANG Xiao-lin, Email:157262879@qq.com

摘要/Abstract

摘要： 目的分析急性戊型病毒性肝炎(AHE)的临床特征及促使黄疸加重及肝衰竭的危险因素。方法回顾性分析2011年至2014年连续收治的AHE患者236例,收集患者的病史、血清学、影像学等临床资料。根据血清TBil水平将患者分为4组:TBil<34 μmol/L,34≤TBil<85 μmol/L,85≤TBil<170 μmol/L,TBil≥170 μmol/L,分析AHE黄疸加重的影响因素。在重度黄疸(TBil≥170 μmol/L)的AHE患者中,根据是否存在凝血酶原时间延长(PTA≤40%),分为肝衰竭组和非肝衰竭组,分析肝衰竭的危险因素。结果老年及男性戊型肝炎患者易出现重度黄疸(P<0.01);存在饮酒史以及合并感染及胆道系统结石者,黄疸水平较高(P<0.05);同时,高胆红素水平还与白细胞、血小板、前白蛋白等指标密切相关。进一步的研究发现,肝衰竭组中存在肝硬化基础的患者,以及合并感染及胆道系统结石者比例显著升高(P<0.05)。 Logistic 回归分析显示,肝硬化基础是戊型肝炎肝衰竭的危险因素。结论多重因素参与AHE的重症化过程。存在肝硬化基础,合并胆道结石及感染的AHE患者易发生肝衰竭。

关键词: 急性戊型肝炎, 重度黄疸, 肝功能衰竭, 临床特征, 危险因素

Abstract: Objective To investigate the clinical features of acute hepatitis E (AHE) and the risk factors for severe jaundice and liver failure.Methods In the retrospective study, a total of 236 patient with AHE in our hospital from 2011 to 2014 were enrolled. To analyze risk factors for severe jaundice with AHE, patients were divided into 4 groups according to total bilirubin (TBil) levels (Group 1:TBil<34 μmol/L, Group 2:34 ≤ TBil<85 μmol/L, Group 3:85 ≤ TBil<170 μmol/L, Group 4:TBil ≥ 170 μmol/L). Additionally, patients with severe jaundice (TBil ≥ 170 μmol/L) were divided into liver failure group and non-liver failure group according to the prothrombin time activity (PTA ≤ 40%) for analyzing the risk factors for hepatitis E virus (HEV)-induced liver failure.Results Severe jaundice tended to occur in elderly male patients (P<0.01). Patients with history of alcohol and biliary stone showed higher level of bilirubin (P<0.05). Meanwhile, high level of bilirubin was associated with white blood cell (WBC), blood platelet (PLT) and pre-albumin. Furthermore, patients with cirrhosis, biliary stone or infection were significantly increased in liver failure group (P<0.05). Cirrhosis was a risk factor for HEV-induced liver failure.Conclusion Several factors were involved in the progression of AHE. Cirrhosis, biliary stone and bacterial infection were risk factors for AHE-induced liver failure.

Key words: Acute hepatitis E, Severe jaundice, Liver failure, Clinical features, Risk factor

史冬梅,王晓琳,项晓刚,谢青. 236例急性戊型肝炎的临床特征及危险因素分析[J]. 肝脏, 2017, 22(6): 498-501.

SHI Dong-mei, WANG Xiao-lin, XIANG Xiao-gang, XIE Qing. Clinical features and risk factors of 236 cases with acute hepatitis E[J]. Chinese Hepatolgy, 2017, 22(6): 498-501.

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