肝脏疾病临床流行病学与肝脏生化临床价值研究

发布时间：2018-05-08 03:20

本文选题：肝病 + 临床　；参考：《河北医科大学》2014年硕士论文

【摘要】：第一部分肝脏疾病临床流行趋势及相关因素研究目的：通过住院病例疾病谱分析，探明肝病临床流行学特征及变化趋势，为高发、多发及危重肝病的防治提供参考依据。方法：收集2005年、2009年、2013年河北医科大学第三医院中西医肝病科住院病人的病例资料。记录一般情况、化验、检查指标，使用SPSS17.0统计处理，统计方法采用卡方检验和方差分析。描述性分析3年肝病流行特征,并对比分析3年疾病谱的变化趋势，进一步探讨其发病和转归的相关因素。结果：结果表明，2005年几类常见肝病占收治病人的比例（例数/总例数）分别是乙型病毒性肝炎（简称乙肝）58.88%（179/304），脂肪性肝病12.50%（38/304），丙型病毒性肝炎（简称丙肝）8.55%（26/304），药物性肝损伤（简称药肝）2.30%（7/304）；2009年分别是乙肝53.98%（271/502），脂肪性肝病22.14%（60/502），丙肝20.76%（54/502），药物性肝损伤9.56%（48/502）；2013年分别是乙肝53.41%（298/558），丙肝13.98%（78/558），药物性肝损伤11.83%（66/558），脂肪性肝病8.42%（47/558）。乙肝占收治肝病的主要部分，丙型病毒性肝炎、药物性肝损伤的比例逐年上升，3年丙肝、药肝所占比例变化有统计学意义，分别是丙肝（χ2=6.187，P=0.045）和药肝（χ2=22.556，P=0.000）。乙肝、脂肪性肝病在性别分布上，男性多于女性，分别是2005年、2009年、2013年乙肝比例（男：女）2.8:1，2.5:1，3.2:1；脂肪性肝病（男：女）11.7:1，4:1，5.7:1。而丙肝、药肝近年女性多于男性，2013年丙肝（男：女）1:1.6，药肝（男：女）1:1.44，其中丙肝3年女性比例变化（2005年，3.95%；2009年，3.78%；2013年，13.98%）有统计学意义（χ2=13.678，P=0.001），药肝男（2005年，1.32%；2009年，4.98%；2013年，4.84%）女（2005年，0.99%；2009年，4.58%；2013年，6.99%）比例变化均有统计学意义，分别是男性（χ2=7.747，P=0.021）和女性（χ2=15.682，P=0.000）。职业分布上，干部比例逐渐减少，农民比例逐渐上升，其中乙肝中干部（2005年，38.55%；2009年，25.46%；2013年，18.18%）（χ2=27.654，P=0.000）、工人（2005年，8.38%；2009年，14.76%；2013年，7.38%）（χ2=8.411，P=0.015），丙肝中干部（2005年，57.69%；2009年，40.74%；2013年，20.51%）（χ2=13.998，P=0.001），药肝中工人（2005年，0.00%；2009年，31.25%；2013年，33.33%）（χ2=6.198，P=0.045）的比例变化均有统计学意义。年龄分布上，住院乙肝病人年龄集中在40~49岁和50~59岁两个年龄段，2009年与2013年年龄变化具有统计学意义（P=0.023）；丙肝病人集中在50~59岁和60~69两个年龄段，2005年、2009年、2013年年龄变化均具有统计学意义（2005vs2009，P1=0.002；2005vs2013，P2=0.000；2009vs2013，P3=0.000）；脂肪性肝病病人集中在40~49岁和50~59岁；药物性肝病病人集中在40~49岁，2005年、2009年、2013年年龄变化均具有统计学意义（2005vs2009，P1=0.003；2005vs2013，P2=0.000；2009vs2013，P3=0.005）。结论：总体上乙肝仍然占收治肝病的主要部分，丙肝、药肝的比例逐年上升。农民占住院病人的比例所占比例越来越大，干部比例越来越小。 1中国乙肝患者数量依然很庞大，需要给予关注并积极预防，，发病年龄集中在中年，男性发病患者多于女性，且大部分人可接受抗病毒治疗。乙肝的防治、诊疗水平有大幅度提升。 2收治的丙肝病人中，近年性别上女性多于男性。丙肝发病较晚，发病年龄偏中老年。 3脂肪性肝病中，近几年酒精性肝病的比例在上升。男女比例上，男性远远多于女性。发病年龄偏中青年，要加强饮食控制、严格限酒方面的宣传。 4药物性肝病中，近年收治的女性患者多于男性，年龄上偏中年。药肝的发病率、死亡率逐年上升，需要引起人们的关注。第二部分γ谷氨酰胺转肽酶与慢性乙型肝炎炎症及纤维化相关性研究目的：分析γ谷氨酰胺转肽酶（GGT）与慢性乙型肝炎病人肝组织病理纤维化及炎症分级之间的相关性，明确GGT数值大小是否可以用来预测慢性乙型肝炎患者肝脏纤维化、炎症的程度。方法：收集2007年至2013年初河北医科大学第三医院中西医肝病科乙肝病人肝穿病理资料，严格按照排除标准和入选标准，整理单纯乙肝病人的病理资料数据，分别按炎症程度由轻到重，分为G0-1（包括G0，G0-1，G1）、G1-2（包括G1+，G2-，G1-2，G2），G2-3（包括G2+，G2-3，G3），G3-4（包括G3+，G3-4，G4）4个组，按纤维化程度分为S0-1（包括S0，S0-1，S1），S1-2(包括S1+，S2-，S1-2，S2)，S2-3(包括S2+，S2-3，S3)，S3-4(包括S3+，S3-4，S4)。应用Excel表和SPSS17.0统计软件对数据进行整理、分析。结果：排除其他合并症，单纯乙型肝炎病理资料共计192例，其中男性141例，女性51例，男女比例2.8:1；平均年龄33.11±12.10；按纤维化分级，S0-1、S1-2、S2-3、S3-4的病例数分别为：77、56、30、29，GGT均值±标准差分别为：25.26±19.11、27.64±23.6、71±60.37、86.07±60.28U/L，其中S0-1、S2-3，S0-1、S3-4，S1-2、S2-3，S1-2、S3-4之间GGT有统计学意义（P＜0.05），S0-1、S1-2间GGT无统计学意义；按炎症分级，G0-1、G1-2、G2-3、G3-4的病例数分别为：60、84、36、2，G0-1、G1-2、G2-3的GGT均值±标准差分别为：20.65±8.64，38.00±45.39，109.73±67.72U/L，其中G0-1、G2-3以及G1-2、G2-3之间差异显著，（P＜0.05），G0-1、G1-2间GGT无统计学意义。结论： 1因诊疗需求进行肝穿患者中，以青年为主，男性多于女性。 2血清GGT水平与乙型肝炎炎症活动度及纤维化程度相关，可能作为预测炎症及肝纤维化程度的标志之一。
[Abstract]:Part 1 clinical trends and related factors of liver diseases
Objective: To explore the clinical epidemiological characteristics and trend of liver disease through the analysis of the disease spectrum of hospitalized cases, so as to provide reference for the prevention and treatment of high incidence, multiple and critical liver diseases.
Methods: the data of hospitalized patients in the Third Hospital of Hebei Medical University, 2005, 2009 and 2013 were collected. The general situation, test, examination index, SPSS17.0 statistical processing, chi square test and variance analysis were used. The epidemiological characteristics of 3 years of liver disease were descriptive and analyzed, and the changes of the 3 year disease spectrum were compared and analyzed. The related factors of morbidity and prognosis were further explored.
Results: the results showed that the proportion of common liver diseases in 2005 was 58.88% (179/304), 12.50% (38/304), 8.55% (26/304), 2.30% (7/304) for hepatitis C, 2.30% (7/304), and 53 of hepatitis B in 2009, respectively. .98% (271/502), fatty liver disease 22.14% (60/502), hepatitis C 20.76% (54/502), drug induced liver injury 9.56% (48/502); in 2013, hepatitis B 53.41% (298/558), hepatitis C 13.98% (78/558), drug induced liver injury 11.83% (66/558), fatty liver disease 8.42% (47/558). Hepatitis B is the main part of liver disease, hepatitis C and drug-induced liver injury. The proportion of the hepatitis C was increased year by year, the proportion of the 3 years of hepatitis C was statistically significant, and they were hepatitis C (x 2=6.187, P=0.045) and drug liver (x 2=22.556, P=0.000). The sex distribution of hepatitis B and fatty liver disease were more than women in 2005, 2009, and 2013 (male: female), respectively, and fatty liver disease (male: Women) 11.7:1,4:1,5.7:1. and hepatitis C, drug liver in recent years more women than men, 2013 hepatitis C (male: female) 1:1.6, drug liver (male: female) 1:1.44, in which 3 years of hepatitis C (2005, 3.95%; 2009, 3.78%; 2013, 13.98%) have statistical significance (2= 13.678, P=0.001), medicine liver male (2005, 1.32%; 2009, 2009, 2013, 2013, 4.84%) women (20 05 years, 0.99%, 2009, 4.58%, 2013, 6.99%) were statistically significant, respectively, men (x 2=7.747, P=0.021) and women (x 2=15.682, P=0.000). Occupational distribution, the proportion of cadres gradually decreased, the proportion of farmers gradually increased, of which hepatitis B (2005, 38.55%; 2009, 25.46%; 2013, 18.18%) (x 2=27.654, P=0.000) Workers (2005, 8.38%; 2009, 14.76%; 2013, 7.38%) (chi 2=8.411, P=0.015), cadres in hepatitis C (2005, 57.69%; 2009, 40.74%; 2013, 20.51%) (x 2=13.998, P=0.001), the proportion of workers in the liver (2005, 0%; 31.25%; 33.33%, 33.33%) (Chi, 2=6.198, 33.33%) were statistically significant. Age distribution, The age of hospitalized patients with hepatitis B was concentrated in two age groups of 40~49 years and 50~59 years. The age changes in 2009 and 2013 were statistically significant (P=0.023). The patients with hepatitis C concentrated in two ages of 50~59 years and 60~69, 2005, 2009, and 2013 were statistically significant (2005vs2009, P1=0.002; 2005vs2013, P2=0.000; 2009vs2013, P. 3=0.000); the patients with fatty liver disease were concentrated at the age of 40~49 and 50~59; the patients with drug-induced liver disease were concentrated at the age of 40~49, in 2005, 2009, and in 2013, the age changes were all statistically significant (2005vs2009, P1=0.003; 2005vs2013, P2=0.000; 2009vs2013, P3=0.005).
Conclusion:
In general, hepatitis B still accounts for the main parts of liver disease. The proportion of hepatitis C and drug liver is increasing year by year. The proportion of farmers in hospitalized patients is increasing, and the proportion of cadres is becoming smaller and smaller.
1 the number of patients with hepatitis B in China is still very large. It needs to pay attention and proactive prevention. The age of the disease is concentrated in middle age, the incidence of male patients is more than that of women, and most people can receive antiviral treatment. The prevention and treatment of hepatitis B and the level of diagnosis and treatment have greatly improved.
2 among the patients with hepatitis C, there were more women than men in recent years.
In 3 fatty liver diseases, the proportion of alcoholic liver disease in recent years is rising. The proportion of men and women is much more than that of women. The age of the disease is more and more middle-aged and young. It is necessary to strengthen the diet control and strictly limit the publicity of the wine.
4 in drug-induced liver disease, in recent years, the number of female patients is more than that of men, and the age is middle-aged. The incidence and mortality of drug-induced liver disease are increasing year by year.
The second part is the relationship between gamma glutamine transpeptidase and inflammation and fibrosis in chronic hepatitis B.
Objective: to analyze the correlation between gamma glutamine transpeptidase (GGT) and the pathological fibrosis and inflammatory classification of liver tissues in patients with chronic hepatitis B, and to determine whether the value of GGT can be used to predict the degree of liver fibrosis and inflammation in patients with chronic hepatitis B.
Methods: the pathological data of liver puncture of hepatitis B patients in the Third Hospital of Hebei Medical University from 2007 to early 2013 were collected, and the pathological data of patients with simple hepatitis B were arranged strictly according to the standard of exclusion and admission. According to the degree of inflammation, they were divided into G0-1 (including G0, G0-1, G1), G1-2 (including G1+, G2-, G1-2, G2), G2-3 (package). G2+, G2-3, G3), G3-4 (including G3+, G3-4, G4), are divided into S0-1 (including S0, S0-1, S1) according to the degree of fibrosis (including S0, S0-1, S1).
Results: excluding other complications, there were 192 cases of simple hepatitis B pathological data, including 141 males and 51 females, the ratio of male and female was 2.8:1, the average age was 33.11 + 12.10. The number of S0-1, S1-2, S2-3, S3-4 were respectively 77,56,30,29 and GGT mean standard deviation was 25.26 + 19.11,27.64 + 23.6,71 + 60.37,86.07 respectively. S0-1, S2-3, S0-1, S3-4, S1-2, S2-3, S1-2, S3-4 GGT have statistical significance (P < 0.05). There was a significant difference between -1, G2-3 and G1-2, G2-3 (P < 0.05), GGT between G0-1 and G1-2 was not statistically significant.
Conclusion:
1 among the patients with liver disease, the majority of them were young people, more men than women.
2 serum GGT level is correlated with the degree of inflammation and fibrosis of hepatitis B, and may be used as a marker of inflammation and liver fibrosis.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575

【参考文献】