丙型肝炎病毒相关慢性肝病与胆囊结石关系的探讨

发布时间：2018-05-07 16:23

本文选题：丙型肝炎病毒 + 慢性肝病　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:通过对1686例丙型肝炎病毒相关慢性肝病患者的胆囊结石发病率、临床特点及相关危险因素进行回顾性分析,探讨不同类型的丙型肝炎病毒相关的慢性肝病与胆囊结石的关系,为此类患者胆囊结石的预防及治疗提供临床及理论依据。方法:抽取我院2008年1月1日至2016年6月30日期间,在肝胆胰内科住院明确诊断为丙型肝炎病毒相关慢性肝病的患者1686例(其中包括慢性丙型肝炎904例、丙肝后肝硬化582例、丙肝后肝硬化伴肝细胞癌157例)以及同期在其他科室住院的非慢性肝病患者1716例,所有患者均行腹部超声检查。首先分析比较慢性丙型肝病与非肝病患者在胆囊结石发病率的差异。其次将各组按有无胆囊结石各分为两组,分析两组间在年龄、性别、Child-Pugh分级、门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、r-谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、白蛋白(ALB)、胆碱酯酶(CHE)、总胆红素(TBIL)、凝血功能等指标之间的差异,并探讨高血压、糖尿病、胆囊炎、脂肪肝等疾病对各组胆囊结石发病率的影响。结果:1.慢性丙型肝炎、丙肝后肝硬化、丙肝后肝硬化合并肝细胞癌的胆囊结石发病率分别为14.71%,30.5%,34.39%,均高于非慢性肝病者(9.67%)(p0.001)。其中,丙肝后肝硬化、丙肝后肝硬化合并肝细胞癌的胆囊结石发病率高于慢性丙型肝炎(p0.001),但丙肝后肝硬化组与肝硬化合并肝癌组比较无统计学差异(p=0.361)。2.慢性丙型肝炎合并胆囊结石的相关危险因素分析:单因素分析显示慢性丙型肝炎合并胆囊结石组的平均年龄、AST、ALT、GGT、ALP、TBIL水平高于无结石组(p0.05),但CHE的平均水平低于无结石组(p0.05);其次,结石组合并高血压、胆囊炎的发生率亦高于无结石组(p0.05)。Logistic回归分析提示高龄(p0.001,OR=1.044,95%CI 1.025-1.064)、AST(p=0.039,OR=1.002,95%CI 1.000-1.004)、胆囊炎(p0.001,OR=2.724,95%CI 1.773-4.185)、是慢性丙型肝炎发生胆囊结石的独立危险因素。3.不同肝功能分级的丙肝后肝硬化患者合并胆囊结石发病率的比较:Child-Pugh B级(33.5%)、C级(36.36%)合并胆囊结石的发病率高于A级(25%)(p=0.041,P=0.036),但B、C级之间胆囊结石发病率无统计学差异(p=0.607)。4.丙肝后肝硬化合并胆囊结石的相关危险因素分析:单变量分析显示丙肝后肝硬化合并胆囊结石的患者平均年龄、TBIL水平以及合并胆囊炎、合并腹水的发生率高于不合并胆囊结石组(p0.05)。Logistic回归分析提示高龄(p=0.018,OR=1.024,95%CI 1.004-1.044)、腹水(p=0.009,OR=1.661,95%CI1.134-2.433)、胆囊炎(p0.001,OR=3.527,95%CI 2.372-5.107)是丙肝后肝硬化合并胆囊结石的独立危险因素。5.丙肝后肝硬化伴肝细胞癌合并胆囊结石的相关危险因素分析:单因素分析显示丙肝后肝硬化伴肝细胞癌合并胆囊结石的患者的平均年龄、ALT、GGT、TBIL水平及合并胆囊炎的发生率高于不合并胆囊结石的患者(p0.05)。Logistic回归分析表明高龄(p=0.003,OR=1.072,95%CI 1.024-1.122)、ALT(p=0.026,OR=1.010,95%CI 1.001-1.019)、胆囊炎(p0.001,OR=6.251,95%CI2.853-13.695)是丙肝后肝硬化伴肝细胞癌存在胆囊结石的独立危险因素。6.非慢性肝病者合并胆囊结石的相关危险因素分析:高龄(p0.001,OR=1.034,95%CI 1.021-1.047)、胆囊炎(p0.001,OR=15.489,95%CI9.828-24.41)、脂肪肝(p=0.013,OR=1.596,95%CI 1.105-2.305)是非肝病患者产生胆囊结石的独立危险因素。结论:1.在丙型肝炎病毒相关的慢性肝病人群中,胆囊结石发病率明显高于非肝病人群,且肝病越严重,胆囊结石的发病率越高,并且在性别表现无统计学差异。2.在丙肝相关的慢性肝病中,高龄及胆囊炎是发生胆囊结石共有的独立危险因素,腹水是丙肝后肝硬化合并胆囊结石的独立危险因素,而脂肪肝的存在导致非肝病患者胆囊结石的发病率更高。
[Abstract]:Objective: To review the incidence, clinical characteristics and related risk factors of 1686 patients with chronic hepatitis C virus related chronic liver disease, and to explore the relationship between different types of hepatitis C virus related chronic liver disease and gallstone, and provide clinical and theoretical basis for the prevention and treatment of cholecystolithiasis in such patients. Methods: from January 1, 2008 to June 30, 2016, 1686 patients with hepatitis C virus associated chronic liver disease (including 904 chronic hepatitis C, 582 cases of liver cirrhosis after hepatitis C, 157 cases of liver cirrhosis after hepatitis C), and non - hospitalized patients in other departments were selected from January 1, 2008 to June 30, 2016. 1716 cases of chronic liver disease, all the patients were examined by abdominal ultrasonography. First, the difference of the incidence of gallstones between chronic hepatitis C and non liver diseases was analyzed and compared. Secondly, the groups were divided into two groups according to or without gallstones, and the age, sex, Child-Pugh classification, aspartate aminotransferase (AST), alanine ammonia were analyzed between the two groups. The effects of basal transferase (ALT), r- glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), albumin (ALB), cholinesterase (CHE), total bilirubin (TBIL), coagulation function and so on, and the influence of hypertension, diabetes, cholecystitis, fatty liver and other diseases on the incidence of cholecystolithiasis in each group. Results: 1. chronic hepatitis C, HCV, liver cirrhosis, The incidence of cholecystolithiasis in hepatitis C cirrhosis complicated with hepatocellular carcinoma were 14.71%, 30.5%, 34.39%, respectively, which were higher than those of non chronic liver disease (9.67%) (p0.001). Analysis of the risk factors related to cholecystolithiasis in chronic hepatitis C (p=0.361).2.: single factor analysis showed that the average age of chronic hepatitis C combined with cholecystolithiasis, AST, ALT, GGT, ALP, TBIL level was higher than that of the non calculi group (P0.05), but the average level of CHE was lower than that of the non calculi group (P0.05); secondly, stone combination. The incidence of hypertension and cholecystitis was also higher than that of the non calculi group (P0.05).Logistic regression analysis suggested that the elderly (p0.001, OR=1.044,95%CI 1.025-1.064), AST (p=0.039, OR=1.002,95%CI 1.000-1.004), cholecystitis (p0.001, OR=2.724,95%CI 1.773-4.185), are independent risk factors for gallstones in chronic hepatitis C Comparison of the incidence of cholecystolithiasis in patients with liver cirrhosis after hepatitis C: Child-Pugh B (33.5%), grade C (36.36%) with cholecystolithiasis is higher than Class A (25%) (p=0.041, P=0.036), but there is no statistical difference in the incidence of cholecystolithiasis between B and C (p=0.607) analysis of risk factors related to cholecystolithiasis in patients with liver cirrhosis after hepatitis C: single The average age, TBIL level and cholecystitis with cholecystitis in patients with hepatic cirrhosis after hepatitis C were analyzed by variable analysis. The incidence of combined ascites was higher than that of non cholecystolithiasis group (P0.05).Logistic regression analysis suggested that the elderly (p=0.018, OR=1.024,95%CI 1.004-1.044), ascites (p=0.009, OR=1.661,95%CI1.134-2.433), and cholecystitis (p0.001, O). R=3.527,95%CI 2.372-5.107) is an independent risk factor for hepatitis C cirrhosis complicated with gallstones. Analysis of risk factors related to cholecystolithiasis in.5. after hepatitis C cirrhosis with hepatocellular carcinoma: the mean age, ALT, GGT, TBIL level, and cholecystolithiasis in patients with hepatic cirrhosis associated with hepatocellular carcinoma with gallstones The incidence of inflammation was higher than that of patients without cholecystolithiasis (P0.05).Logistic regression analysis showed that age (p=0.003, OR=1.072,95%CI 1.024-1.122), ALT (p=0.026, OR=1.010,95%CI 1.001-1.019), cholecystitis (p0.001, OR=6.251,95%CI2.853-13.695) was an independent risk factor for gallstones in the liver with hepatocellular carcinoma after hepatitis C and non chronic.6. Analysis of related risk factors for hepatolithiasis with cholecystolithiasis: p0.001 (OR=1.034,95%CI 1.021-1.047), cholecystitis (p0.001, OR=15.489,95%CI9.828-24.41), and fatty liver (p=0.013, OR=1.596,95%CI 1.105-2.305) are the independent risk factors for gallstones in patients with non liver disease. Conclusion: 1. in patients with chronic hepatitis C virus related chronic liver disease, patients with hepatitis C virus are associated with chronic liver disease. In the group, the incidence of cholecystolithiasis is significantly higher than that of non liver diseases. The more serious the liver disease is, the higher the incidence of gallstones, and there is no statistical difference in sex expression in the chronic hepatitis C related chronic liver diseases. The age and cholecystitis are the independent risk factors of cholecystolithiasis, and the ascites are after the hepatitis C cirrhosis with gallstones. Independent risk factors, and the presence of fatty liver causes higher incidence of gallstones in patients with non liver diseases.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.63;R575.62

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