156例散发性急性戊型肝炎临床特征分析

发布时间：2018-04-25 23:39

本文选题：散发性 + 戊型肝炎　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:戊型肝炎病毒(Hepatitis E virus,HEV)是引起急性戊型肝炎(Acute Hepatitis E,AHE)的病原体,目前已成为公共卫生领域的关注的热点问题,主要有暴发流行和散发两种传播形式,本次研究探讨我院散发性戊型病毒性肝炎流行病学和临床特征,分析AHE组、AHE重叠慢性肝病以及老年AHE患者的临床特点及相关因素,为进一步的研究提供依据。方法:收集安徽医科大学第一附属医院2012年1月-2015年12月在感染病科住院的156例散发性急性戊型肝炎的患者的临床资料和数据,并按照如下方法进行分组比较和分析:1.按照患者感染的形式分组,将感染HEV患者分为AHE组和AHE重叠慢性肝病组,其中慢性肝病中包括慢性乙型病毒性肝炎,酒精性肝病,乙型肝炎后肝硬化,分别比较这三类人群与AHE组的异同;2.按照患者年龄层次划分,分为非老年组(年龄60岁)和老年组(年龄≥60岁),分析两组数据之间的不同以及影响老年戊肝患者病程的相关因素。3.应用多元线性回归分析方法分析戊型肝炎淤胆的相关因素及影响住院时间的相关因素。1.按照患者感染的形式分组,将感染HEV患者分为AHE组和AHE重叠慢性肝病组,其中慢性肝病中包括慢性乙型病毒性肝炎,酒精性肝病,乙型肝炎后肝硬化,分别比较这三类人群与AHE组的异同;2.按照患者年龄层次划分,分为非老年组(年龄60岁)和老年组(年龄≥60岁),分析两组数据之间的不同以及影响老年戊肝患者病程的相关因素。3.应用多元线性回归分析方法分析戊型肝炎淤胆的相关因素及影响住院时间的相关因素。结果1.本次研究我院156例戊型病毒性肝炎中,男性129例,女性27例,男:女为4.7:1;年龄14~79岁,平均年龄为(52.9±12.7)岁;戊型肝炎全年散发,发病时节以春季(1-3月)发病例数例数居多(n=66,42.30%),单月以2月份高发(32/156,20.51%);发病患者的职业特征中,从事务农务工占共计124例(79.48%),其他职业32例(20.51%)。发病区域特点:农村患者105例(67.30%),城市患者51例(32.69%)。2.临床分型中,急性黄疸型135例(86.53%),无黄疸型21例(13.46%),急性淤胆型肝炎72例(46.15%),重型肝炎11例(7.05%);感染形式中,单纯AHE组78例(50.00%),AHE合并慢性肝病共78例(50.00%),其中AHE重叠慢性乙型肝炎感染20例(12.82%),AHE合并酒精性肝病共37例(23.71%),AHE重叠乙肝肝硬化21例(13.46%);1.本次研究我院156例戊型病毒性肝炎中,男性129例,女性27例,男:女为4.7:1;年龄14~79岁,平均年龄为(52.9±12.7)岁;戊型肝炎全年散发,发病时节以春季(1-3月)发病例数例数居多(n=66,42.30%),单月以2月份高发(32/156,20.51%);发病患者的职业特征中,从事务农务工占共计124例(79.48%),其他职业32例(20.51%)。发病区域特点:农村患者105例(67.30%),城市患者51例(32.69%)。2.临床分型中,急性黄疸型135例(86.53%),无黄疸型21例(13.46%),急性淤胆型肝炎72例(46.15%),重型肝炎11例(7.05%);感染形式中,单纯AHE组78例(50.00%),AHE合并慢性肝病共78例(50.00%),其中AHE重叠慢性乙型肝炎感染20例(12.82%),AHE合并酒精性肝病共37例(23.71%),AHE重叠乙肝肝硬化21例(13.46%);3.年龄层次分布中,非老年组(年龄60岁)共计99例,其中青年组(40岁)17例(10.89%),中年组(41~59岁)82例(52.56%),老年组(≥60岁)共计57例(36.54%),年龄层次主要分布在中年人群;4.AHE重叠慢性肝病中,以AHE合并酒精性肝病例数最多(37/78,47.43%),AHE重叠慢性乙型病毒性肝炎胆红素高峰水平明显高于单纯感染组,差异具有统计学意义(P0.05),白蛋白、ALT/AST比值、TBA和PT水平未见明显差异;AHE重叠乙肝肝硬化组,白蛋白、ALT/AST比值低于单纯AHE组,TBA及PT水平高于单纯感染组,差异具有统计学意义(P0.05);5.老年AHE患者组平均住院时间及黄疸高峰值大于非老年组,白蛋白及ALT/AST比值低于非老年组,老年组发生重型肝炎的几率大于非老年组,差异均具有统计学意义(P0.05);6.本次对住院时间大于三周以上(住院天数≥21天)的患者一共50例,利用多元线性回归方程显示住院时间与性别、年龄、ALB、GLB、TBIL、ALT、TBA成正性相关关系,与AST、ALP、PT和PTA成负性相关关系。性别,年龄,入院时TBIL值和ALT/AST比值是影响住院时间的相关因素。结论1.本院2012年至2015年156例急性戊型肝炎患者中,均为散发,未见群体发病,男性发病率高于女性,发病年龄段主要集中在中年人群;2.单纯AHE以急性黄疸型肝炎多见,AHE合并慢性肝病较单纯AHE组病情重,其中以AHE合并酒精性肝病患者居多,而AHE重叠慢性乙型肝炎及乙型肝炎肝硬化患者住院时间延长,易发生多种并发症,重型肝炎发生率增加,影响病情恢复;3.老年AHE患者容易合并淤胆,发生重型肝炎的几率高,恢复时间长,需注意老年AHE患者病情重,应给予密切关注;4.男性,年龄,胆红素高峰,入院时ALT/AST比值和PT值是影响住院时间的相关因素。1.本院2012年至2015年156例急性戊型肝炎患者中,均为散发,未见群体发病,男性发病率高于女性,发病年龄段主要集中在中年人群;2.单纯AHE以急性黄疸型肝炎多见,AHE合并慢性肝病较单纯AHE组病情重,其中以AHE合并酒精性肝病患者居多,而AHE重叠慢性乙型肝炎及乙型肝炎肝硬化患者住院时间延长,易发生多种并发症,重型肝炎发生率增加,影响病情恢复;3.老年AHE患者容易合并淤胆,发生重型肝炎的几率高,恢复时间长,需注意老年AHE患者病情重,应给予密切关注;4.男性,年龄,胆红素高峰,入院时ALT/AST比值和PT值是影响住院时间的相关因素。
[Abstract]:Objective: Hepatitis E virus (HEV) is the pathogen causing acute hepatitis E (Acute Hepatitis E, AHE). At present, it has become a hot issue in the public health field. It mainly has two forms of epidemic and dissemination. This study explored the epidemiological and clinical characteristics of sporadic HEV hepatitis in our hospital. The clinical characteristics and related factors of AHE group, AHE overlapping chronic liver disease and elderly AHE patients were analyzed. Methods: the clinical data and data of 156 patients with acute sporadic hepatitis E in the First Affiliated Hospital of Medical University Of Anhui in December January 2012 -2015 were collected and the clinical data and data were collected. Subgroup comparison and analysis: 1. according to the form of patient infection group, the HEV patients were divided into AHE group and AHE overlapping chronic liver disease group. Chronic liver disease included chronic hepatitis B, alcoholic liver disease, and hepatitis B cirrhosis, compared the similarities and differences between the three groups and the AHE group; 2. according to the age level of the patients. Classification, divided into non aged group (age 60) and aged group (age > 60 years old), analysis of the difference between the two groups of data and the related factors affecting the course of disease in the elderly patients with hepatitis E,.3. applied multivariate linear regression analysis to analyze the related factors of cholestasis of hepatitis E and the related factors affecting the time of residence,.1. according to the form of patient infection. The patients with HEV were divided into AHE group and AHE overlapping chronic liver disease group. Chronic liver disease included chronic hepatitis B, alcoholic liver disease, and hepatitis B cirrhosis, compared the similarities and differences between the three groups and the AHE group, and 2. according to the age level of the patients, they were divided into non aged group (age 60 years old) and old group (age 60 years old), Analysis of the differences between the two groups of data and the related factors affecting the course of the elderly patients with hepatitis E,.3. applied multivariate linear regression analysis to analyze the related factors of cholestasis of hepatitis E and the related factors affecting the time of hospitalization. Results 1. in 156 cases of hepatitis E virus hepatitis in our hospital, 129 cases were male, 27 women were female, male was 4.7:1; Age 14~79 years, the average age was (52.9 + 12.7) years; hepatitis E was distributed throughout the year. The number of cases in spring (1-3 months) was most (n=66,42.30%), and the month was high in February (32/156,20.51%). Among the occupational characteristics of the patients, 124 cases (79.48%) and 32 other occupations (20.51%). The village patients were 105 (67.30%), 51 (32.69%).2. clinical classification, 135 cases of acute jaundice (86.53%), 21 cases without jaundice (13.46%), 72 cases of acute cholestatic hepatitis (46.15%), 11 cases of severe hepatitis (7.05%). In the form of infection, there were 78 cases in group AHE, AHE combined with chronic liver disease, of which AHE overlapped chronic hepatitis B Infection in 20 cases (12.82%), AHE with alcoholic liver disease in 37 cases (23.71%), AHE overlapped hepatitis B cirrhosis in 21 cases (13.46%); 1. in our hospital 156 cases of hepatitis E virus hepatitis, male 129 cases, 27 women, male: 4.7:1, age 14~79 years, average age of (52.9 + 12.7) years, hepatitis E all the year out, the onset of disease in the spring (1-3 months) onset The number of cases (n=66,42.30%) and high incidence of February (32/156,20.51%); among the occupational characteristics of the patients, 124 cases (79.48%), 32 cases (20.51%) of other occupations, 105 cases (67.30%) of rural patients, 51 cases of urban patients (32.69%).2. clinical classification, 135 (86.53%) with acute jaundice (86.53%), no jaundice. There were 21 cases (13.46%), 72 cases of acute cholestatic hepatitis (46.15%), 11 cases of severe hepatitis (7.05%), 78 cases in AHE group (50%), 78 patients with chronic liver disease (50%), AHE with chronic hepatitis B infection (12.82%), AHE combined with alcoholic liver disease (23.71%), AHE overlapped hepatitis B cirrhosis. In the hierarchical distribution, there were 99 cases in the non aged group (age 60), of which 17 (10.89%) in the young group (10.89%), 82 (52.56%) in the middle age group (41~59 years) and 57 (36.54%) in the elderly group (36.54%), and the age level was mainly in the middle age group; in the 4.AHE overlapping slow liver disease, the number of AHE combined with alcoholic liver disease was the most (37/78,47.43%) and AHE overlapped the chronic chronic disease. The peak level of bilirubin in viral hepatitis B was significantly higher than that in simple infection group (P0.05), and there was no significant difference in the level of albumin, ALT/AST, TBA and PT. The ratio of albumin and ALT/AST in AHE overlapped hepatitis B liver cirrhosis group was lower than that in pure AHE group, and the level of TBA and PT was higher than that of the simple infection group (P0., P0.). The difference was statistically significant (P0.). 05): 5. the average length of hospitalization and jaundice in the elderly AHE patients were higher than those in the non elderly group, and the ratio of albumin to ALT/AST was lower than that in the non elderly group. The incidence of severe hepatitis in the elderly group was greater than that in the non elderly group (P0.05); the 6. patients with more than three weeks of hospitalization more than three weeks (hospitalization days more than 21 days) had 50 cases. Multiple linear regression equations were used to show the positive correlation between hospitalization time and sex, age, ALB, GLB, TBIL, ALT, TBA, and negative correlation with AST, ALP, PT and PTA. Sex, age, TBIL value and ALT/AST ratio at admission were related factors affecting the time of hospitalization. Conclusion 1. patients with acute hepatitis E from 2012 to 2015 in our hospital were 156 cases, There were no group morbidity, male incidence was higher than that of women, age of onset mainly concentrated in middle age group; 2. simple AHE with acute jaundice hepatitis, AHE combined with chronic liver disease more severe than simple AHE group, among which AHE combined alcoholic liver disease patients were most, and AHE overlapped chronic hepatitis B and hepatitis B cirrhosis patients. The prolonged hospitalization time is easy to have a variety of complications, the incidence of severe hepatitis is increased and the condition of the disease is restored. 3. elderly AHE patients are easy to merge with cholestasis, high probability of severe hepatitis and long recovery time. We should pay close attention to the condition of elderly AHE patients and should pay close attention; 4. male sex, age, peak of bilirubin, ALT/AST ratio and PT value at admission are shadow. Related factors of the time of hospitalization.1. in our hospital from 2012 to 2015, 156 cases of acute hepatitis E were sporadic, and there was no group disease. The incidence of male was higher than that of women. The age of the disease was mainly concentrated in the middle age group; 2. simple AHE with acute jaundice hepatitis, AHE combined with chronic liver disease more severe than that of the simple AHE group, which was combined with AHE. There are many patients with alcoholic liver disease, while AHE overlaps with chronic hepatitis B and hepatitis B liver cirrhosis in patients with prolonged hospitalization, many complications are easy to occur, the incidence of severe hepatitis is increased, and the condition of 3. elderly AHE patients is easy to merge with cholestasis, the chances of severe hepatitis are high, and the time of recovery is long, so it is necessary to pay attention to the serious condition of the elderly AHE patients. Should pay attention to the condition of the elderly patients. Close attention was given; 4. men, age, peak of bilirubin, ALT/AST ratio at admission and PT were related factors of hospitalization time.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.6

【参考文献】