青海地区酒精性肝病201例临床特点分析

发布时间：2018-10-20 19:40

【摘要】：目的对青海地区酒精性肝病（alcoholic liver disease，ALD）患者的临床病历资料进行分析，探讨酒精性肝病的发病情况、总结其临床特点及预后，以提高对ALD的认识，为早期诊断、早期治疗ALD提供临床依据。方法对2008年1月至2013年11月于青海大学附属医院住院确诊的201例ALD患者的临床病历资料进行回顾性分析，分析酒精性脂肪肝(alcoholic fatty liver，AFL)、酒精性肝炎(alcoholic hepatitis，AH)和酒精性肝硬化（alcoholic cirrhosis，AC)三组的年龄、职业、肥胖、饮酒量、饮酒时间与ALD的关系，进一步分析饮酒量、饮酒时间对肝硬化Child-Pugh分级的影响；比较三组间生化和影像学指标的差异；分析部分ALD患者多次住院及死亡原因；分析Maddrey函数与ALD的不同病情和预后的关系。结果AFL组患病年龄主要在31-40岁之间，AH和AC组患病年龄主要在41-50岁之间；工人和干部饮酒者较多，AFL组以肥胖患者为主。ALD的发病与饮酒量、饮酒时间有关。肝硬化Child-Pugh分级A、B、C三级的饮酒量组间比较差异有统计学意义（p＜0.05），而饮酒时间组间比较差异无统计学意义（p＞0.05）。肝功能检测AST/ALT、A/G、TCH、TG、HDL组间比较差异有统计学意义（p＜0.05），随着肝损害的加重，A/G、TCH、TG、HDL呈逐渐下降，，而AST/ALT则呈逐渐升高。门静脉血流速度组间比较差异有统计学意义（p＜0.05），且随肝损害加重而减慢；肝/脾CT值组间比较无统计学意义（p＞0.05）。ALD患者多次住院和死亡的主要原因是肝硬化的晚期并发症，上消化道出血居首位。不同病情和预后患者的Maddrey函数评分差异均有统计学意义（p＜0.05）。结论青海地区男性是ALD的主要患病人群，临床特点无特异性；ALD的病情和预后与长期大量饮酒有关；Maddrey函数与病情轻重及预后关系密切；ALD患者多次住院和死亡的首要原因为上消化道出血；对饮酒者应定期检测相关血生化及影像学指标；从而争取早诊断、早治疗、改善预后。
[Abstract]:Objective to analyze the clinical records of patients with alcoholic liver disease (alcoholic liver disease,ALD) in Qinghai area, to explore the incidence of alcoholic liver disease, and to summarize its clinical characteristics and prognosis, so as to improve the understanding of ALD and to make early diagnosis. Early treatment of ALD provides clinical basis. Methods from January 2008 to November 2013, the clinical records of 201 patients with ALD diagnosed in the affiliated Hospital of Qinghai University were retrospectively analyzed. To analyze the relationship among age, occupation, obesity, alcohol consumption, drinking time and ALD in the three groups of alcoholic fatty liver (alcoholic fatty liver,AFL), alcoholic hepatitis (alcoholic hepatitis,AH) and alcoholic cirrhosis (alcoholic cirrhosis,AC). To compare the differences of biochemical and imaging indexes among the three groups, to analyze the causes of hospitalization and death of some ALD patients, and to analyze the relationship between Maddrey function and the different condition and prognosis of ALD. Results the prevalence age of AFL was mainly between 31 and 40 years old, that of AH and AC group was between 41 and 50 years old, that of workers and cadres drinking alcohol was more, and that of AFL group was mainly obesity. The incidence of ALD was related to the amount of alcohol consumed and the time of drinking. There was a significant difference in alcohol consumption between the three groups (p < 0. 05), but there was no significant difference between the drinking time groups (p > 0. 05). There was significant difference in liver function test between AST/ALT,A/G,TCH,TG,HDL groups (p < 0. 05). With the exacerbation of liver damage, the level of AST/ALT decreased gradually, while AST/ALT increased gradually. There was significant difference in portal vein blood flow velocity between the two groups (p < 0. 05), and it slowed down with the exacerbation of liver damage, but there was no significant difference between the two groups (p > 0. 05). ALD). The main cause of hospitalization and death in patients with liver cirrhosis was the late complications of cirrhosis, and there was no significant difference between the two groups (p > 0. 05). Upper gastrointestinal bleeding was the first. The scores of Maddrey function in patients with different conditions and prognosis were significantly different (p < 0. 05). Conclusion in Qinghai, men are the main patients with ALD, the clinical characteristics are not specific, the condition and prognosis of ALD are related to long-term heavy drinking, the Maddrey function is closely related to the severity of the disease and prognosis. The primary cause of hospitalization and death in patients with ALD is upper gastrointestinal hemorrhage, and the related biochemical and imaging indexes should be detected regularly for drinkers, so as to make early diagnosis, early treatment and improve prognosis.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.5

【参考文献】