丙型肝炎后肝硬化的影响因素分析

发布时间：2018-05-27 06:20

本文选题：丙型肝炎病毒 + 慢性丙型肝炎　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:本研究旨在了解慢性丙型肝炎及丙型肝炎后肝硬化患者的人口学特征,行为生活方式、临床特点等相关因素的暴露情况,用病例对照研究方法探讨丙型肝炎后肝硬化的影响因素,为降低丙型肝炎后肝硬化的发生,提高患者的生活质量提供科学依据。方法:收集2010年6月-2016年6月于山西省晋城市第三人民医院及山西省晋城市人民医院明确诊断为慢性丙型肝炎及丙型肝炎后肝硬化住院患者共219例作为研究对象,对所有研究对象,依据2016年更新版《丙型肝炎防治指南》及患者临床症状、体征、生化检查、影像学检查结果分为两组,一组为病例组,由丙型肝炎后肝硬化患者组成,一组为对照组,由慢性丙型肝炎患者组成,两组均采集患者身高、体重,并计算身体质量指数,空腹采取静脉血检测丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、白蛋白(ALB)、总胆固醇(TC)、甘油三酯(TG)、空腹血糖(FBG)以及丙肝抗体(抗-HCV)、丙型肝炎病毒量(HCV-RNA)、丙型肝炎基因分型等。采用?2进行单因素分析,非条件logistic回归进行多因素分析。相乘交互作用采用logistic回归模型分析。相加交互作用采用Andersson等[33]编制的Excel软件进行分析。结果:1.本次研究结果显示:(1)研究对象中男女比例为1:1.46,女性占59.36%,男性占40.64%。(2)年龄大于等于60岁中丙型肝炎后肝硬化患者所占比例较高(52.94%),50~60岁及40~50岁中丙型肝炎后肝硬化患者所占比例分别为23.53%和22.35%,小于40岁的丙型肝炎后肝硬化患者所占比例较低,单因素分析差异有统计学意义(?2=32.390,P0.001)。(3)已婚的丙型肝炎后肝硬化患者所占比例为98.82%,高于未婚丙型肝炎后肝硬化患者(1.18%)。但无统计学意义(?2=2.421,P=0.121)。职业为农民和工人的丙型肝炎后肝硬化患者所占比例为71.76%,其他职业丙型肝炎后肝硬化患者所占比例为28.24%,差异无统计学意义(?2=0.51,P=0.473)。2.影响丙型肝炎后肝硬化的单因素分析显示:吸烟、有肝病家族史、感染后有明显临床表现、合并HBV感染、糖尿病、高血压,未接受抗病毒治疗、AST≥40U/L、PTA80%、感染年限为1~3年者增加丙型肝炎后肝硬化的发病风险,差异有统计学意义(P0.05)。3.影响丙型肝炎后肝硬化的多因素分析显示:控制性别、年龄、是否吸烟、是否有乙肝家族史、是否合并HBV感染、是否合并高血压、PTA80%、丙型肝炎基因分型后,感染年限长(OR,OR95%CI:3.047,1.010~9.192;3.327,1.344~8.239)、感染后有明显临床表现(OR,OR95%CI:5.797,2.558~13.137)、合并糖尿病(OR,OR95%CI:7.169,2.182~23.557)、AST≥40U/L(OR,OR95%CI:3.242,1.496~7.024)、BMI≥28(OR,OR95%CI:2.663,1.160~6.114)是丙型肝炎后肝硬化的危险因素;接受抗病毒治疗(OR,OR95%CI:0.370,0.165~0.833)是丙型肝炎后肝硬化的保护因素。4.交互作用结果显示:各因素之间未发现有相乘和相加交互作用。结论:慢性丙型肝炎患者中,感染年限较长、感染后有明显临床表现、合并糖尿病、AST升高及肥胖者,会增加其发展为丙型肝炎后肝硬化的风险;而接受正规抗病毒治疗者,可以降低丙型肝炎后肝硬化的发生风险。
[Abstract]:Objective: This study aims to understand the demographic characteristics, behavioral lifestyle, clinical characteristics and other related factors of chronic hepatitis C and HCV patients, and to explore the influencing factors of post hepatitis C cirrhosis by case control study, in order to reduce the incidence of HCV and improve the life of patients with hepatitis C. Methods: a total of 219 cases of hospitalized patients with chronic hepatitis C and hepatitis C were diagnosed in the third people's Hospital of Jincheng, Jincheng, Shanxi, and the people's Hospital of Jincheng, Shanxi Province, June 2010, in June -2016 years. The clinical symptoms, signs, biochemical tests, and imaging findings were divided into two groups. One group was a case group, composed of patients with hepatitis C and cirrhosis, a control group, a control group, a chronic hepatitis C patient, and two groups of patients who were measured in height, weight, and calculated body mass index, and vierine venous blood was used to detect alanine aminoamine. Transferase (ALT), aspartate aminotransferase (AST), albumin (ALB), total cholesterol (TC), triglyceride (TG), fasting blood glucose (FBG), hepatitis C antibody (anti -HCV), hepatitis C virus (HCV-RNA), hepatitis C gene typing, and so on. Use? 2 for single factor analysis and non conditional logistic regression for multifactor analysis. Multiplicative interaction The logistic regression model was used to analyze the addition of Excel software such as Andersson and other [33]. Results: 1. the results of the study showed: (1) the proportion of men and women in the study was 1:1.46, women accounted for 59.36%, and the male accounted for (2) age greater than 60 years of hepatitis C (52.94%), 50~6 The proportion of patients aged 0 and 40~50 was 23.53% and 22.35% respectively, and the proportion of patients less than 40 years old was lower. The difference in single factor analysis was statistically significant (? 2=32.390, P0.001). (3) the proportion of patients with hepatitis C after hepatitis C was 98.82%, higher than that of unmarried hepatitis C. Liver cirrhosis (1.18%). But there is no statistical significance (? 2=2.421, P=0.121). The proportion of patients with post hepatitis C cirrhosis in the occupation is 71.76%, the proportion of other occupational hepatitis C patients is 28.24%, the difference is not statistically significant (? 2= 0.51, P=0.473).2. affects the single factor analysis of hepatitis C cirrhosis It shows: smoking, family history of liver disease, obvious clinical manifestation after infection, combined with HBV infection, diabetes, hypertension, unreceived antiviral treatment, AST > 40U/L, PTA80%, 1~3 years of infection increase the risk of hepatitis C cirrhosis, the difference is statistically significant (P0.05).3. affects the multiple factors analysis of hepatitis C after hepatitis C Show: control sex, age, smoking, family history of hepatitis B, HBV infection, combined hypertension, PTA80%, hepatitis C genotyping, infection years (OR, OR95%CI:3.047,1.010~9.192; 3.327,1.344~8.239), after infection (OR, OR95%CI:5.797,2.558~13.137), combined with diabetes (OR, OR95%CI:7.169). 2.182~23.557), AST > 40U/L (OR, OR95%CI:3.242,1.496~7.024), BMI > 28 (OR, OR95%CI:2.663,1.160~6.114) is a risk factor for posthepatitic cirrhosis; the acceptance of antiviral therapy (OR, OR95%CI:0.370,0.165~0.833) is a protective factor for the protection factor of hepatitis C after hepatitis C, and the result shows that there is no multiplication and phase between the factors. Conclusion: in patients with chronic hepatitis C, there is a long period of infection and obvious clinical manifestation after infection. The combination of diabetes, elevated AST and obesity will increase the risk of the development of HCV after hepatitis C, and the risk of cirrhosis after hepatitis C can be reduced by regular antiviral therapy.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.63;R575.2

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