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急性戊型肝炎严重黄疸患者的临床特征及危险因素分析

刘玉 梅雪 张宇一 邹颖 张正国 郭红英 袁伟 王介非 钱志平

刘玉, 梅雪, 张宇一, 等. 急性戊型肝炎严重黄疸患者的临床特征及危险因素分析[J]. 临床肝胆病杂志, 2021, 37(3): 565-569. DOI: 10.3969/j.issn.1001-5256.2021.03.013
引用本文: 刘玉, 梅雪, 张宇一, 等. 急性戊型肝炎严重黄疸患者的临床特征及危险因素分析[J]. 临床肝胆病杂志, 2021, 37(3): 565-569. DOI: 10.3969/j.issn.1001-5256.2021.03.013
LIU Y, MEI X, ZHANG YY, et al. Clinical features and risk factors of acute hepatitis E with severe jaundice[J]. J Clin Hepatol, 2021, 37(3): 565-569. DOI: 10.3969/j.issn.1001-5256.2021.03.013
Citation: LIU Y, MEI X, ZHANG YY, et al. Clinical features and risk factors of acute hepatitis E with severe jaundice[J]. J Clin Hepatol, 2021, 37(3): 565-569. DOI: 10.3969/j.issn.1001-5256.2021.03.013

急性戊型肝炎严重黄疸患者的临床特征及危险因素分析

DOI: 10.3969/j.issn.1001-5256.2021.03.013
基金项目: 

国家"十三五"科技重大专项 2018ZX10725506-002

2018年院级科研课题 KY-GW-2018-23

详细信息
    作者简介:

    刘玉(1984—),女,主治医师,主要从事病毒性肝炎等肝病临床研究

    通讯作者:

    钱志平,qianzhiping@shphc.org.cn

  • 利益冲突声明:本研究不存在研究者与公开研究成果有关的利益冲突,特此声明。
  • 作者贡献声明:刘玉负责课题设计,撰写论文;梅雪、张宇一、邹颖、张正国负责收集数据及资料分析;郭红英、袁伟负责修改论文;王介非、钱志平指导撰写文章并最后定稿。
  • 中图分类号: R512.6

Clinical features and risk factors of acute hepatitis E with severe jaundice

  • 摘要:   目的  分析伴或不伴严重黄疸的急性戊型肝炎患者的临床特征,并探究发生严重黄疸的危险因素。  方法  回顾性分析2018年1月1日—2020年3月26日上海市公共卫生临床中心收治的179例急性戊型肝炎患者的临床资料。根据TBil是否>171 μmol/L分为AHE伴轻度黄疸(AHE-M)组和AHE伴严重黄疸(AHE-S)组,比较两组临床资料及实验室检查指标。两组间比较采用t检验、Mann-Whitney U检验或χ2检验,独立危险因素分析采用二元logistic回归。  结果  179例患者56.42%(101例)伴严重黄疸。与AHE-M组比较,AHE-S组男性占比多(80.20% vs 61.54%, χ2=7.612, P=0.006),住院时间长[29(19~45)d vs 18(14~22)d, Z=-6.035, P<0.001],发生肝衰竭的人数多[23 vs 0, χ2=18.373, P<0.001],预后差(P<0.001)。AHE-S组基线的抗-HEV-IgM、AFP、肝脏弹性值均高于AHE-M组(Z值分别为-3.534、-3.588、-4.496,P值均<0.001),基线的CD4低于AHE-M组(Z=-2.015,P<0.05),TBil、DBil、肌酐、凝血酶原时间、INR、中性粒细胞绝对数的峰值均高于AHE-M组(Z值分别为-11.016、-10.926、-2.726、-4.787、-4.989、-6.016,P值均<0.01),GGT的峰值、白蛋白、前白蛋白、淋巴细胞绝对数的谷值均低于AHE-M组(Z值分别为-4.550、-4.685、-5.087、-4.818,P值均<0.001)。logistic回归分析显示抗-HEV-IgM(OR=1.022,95%CI: 1.005~1.039,P=0.012)、GGT(OR=0.995,95%CI: 0.993~0.998,P=0.001)、前白蛋白(OR=0.991,95%CI: 0.983~0.999,P=0.02)、中性粒细胞(OR=1.486,95%CI: 1.169~1.889,P=0.001)是急性戊型肝炎患者出现严重黄疸的独立危险因素。  结论  急性戊型肝炎严重黄疸患者男性占比多,住院时间长,发生肝衰竭人数多,预后差,抗-HEV-IgM、GGT、前白蛋白、中性粒细胞是急性戊型肝炎患者出现严重黄疸的独立危险因素。
  • 图  1  两组不同年龄组发病人数比较

    表  1  两组临床资料比较

    指标 AHE-M(n=78) AHE-S(n=101) 统计值 P
    男性[例(%)] 48(61.54) 81(80.20) χ2=7.612 0.006
    年龄(岁) 57.40±13.98 61.31±15.49 t=-1.745 0.083
    BMI(kg/m2) 23.97±1.89 23.53±1.54 t=1.661 0.099
    吸烟史[例(%)] 12(15.38) 12(11.88) χ2=0.465 0.495
    饮酒史[例(%)] 13(16.67) 22(21.78) χ2=0.732 0.392
    合并基础肝病 12(15.38) 25(24.75) χ2=2.355 0.125
      甲型肝炎/丙型肝炎(例) 0 1/1
      乙型肝炎[例(%)] 7(8.97) 13(12.87) χ2=0.673 0.412
      肝硬化[例(%)] 2(2.56) 8(7.41) χ2=2.394 0.122
      脂肪肝[例(%)] 3(3.85) 1(0.99) χ2=1.328 0.249
      酒精肝[例(%)] 3(3.85) 3(2.97) χ2=0.029 0.864
    合并其他基础疾病[例(%)]
      糖尿病 10(12.82) 13(12.87) χ2=0.000 0.992
      高血压 22(28.21) 30(29.70) χ2=0.048 0.827
    发热[例(%)] 29(37.18) 28(27.72) χ2=1.813 0.178
    发病到入院时间(d) 7.5(7.0~14.0) 10.0(7.0~14.0) Z=-1.728 0.084
    住院时间(d) 18(14~22) 29(19~45) Z=-6.035 <0.001
    发生肝衰竭人数[例(%)] 0 23(22.77) χ2=18.373 <0.001
    好转/无效/死亡人数(例) 77/0/1 81/8/12 χ2=14.457 <0.001
    下载: 导出CSV

    表  2  两组实验室指标比较

    实验室指标 AHE-M(n=78) AHE-S(n=101) 统计值 P
    抗-HEV-IgM基线(S/CO) 20.18(3.38~40.1) 38.19(12.67~52.02) Z=-3.534 <0.001
    ALT峰值(U/L) 1421(640~2469) 1151(630~2246) Z=-0.720 0.472
    AST峰值(U/L) 919.00(315.65~1622.15) 753.00(410.00~1441.50) Z=-0.550 0.582
    ALP峰值(U/L) 162(127~221) 167(130~205) Z=-0.102 0.919
    GGT峰值(U/L) 220.00(135.75~352.25) 123.00(85.50~212.50) Z=-4.550 <0.001
    LDH峰值(U/L) 253.50(200.00~348.75) 249.00(200.50~339.00) Z=-0.032 0.974
    TBil峰值(μmol/L) 91.60(40.20~127.58) 325.00(222.55~490.00) Z=-11.016 <0.001
    DBil峰值(μmol/L) 64.80(22.30~96.40) 222.20(157.00~350.55) Z=-10.926 <0.001
    白蛋白谷值(g/L) 35.00(32.44~38.10) 31.90(28.65~35.00) Z=-4.685 <0.001
    前白蛋白谷值(mg/L) 98.20(71.49~148.25) 58.50(28.16~93.55) Z=-5.087 <0.001
    肌酐峰值(μmol/L) 61.56(53.81~70.88) 68.40(57.20~87.74) Z=-2.726 0.006
    凝血酶原时间峰值(s) 13.80(13.10~14.73) 14.09(13.80~19.35) Z=-4.787 <0.001
    INR峰值 1.05(0.98~1.14) 1.17(1.06~1.64) Z=-4.989 <0.001
    中性粒细胞峰值(109/L) 2.98(2.21~3.93) 4.80(3.37~6.89) Z=-6.016 <0.001
    淋巴细胞谷值(109/L) 1.52±0.57 1.13±0.51 t=-4.818 <0.001
    CD4绝对数基线(cell/μl) 540.19±209.99 473.62±225.99 t=-2.015 0.045
    AFP基线(ng/ml) 6.38(3.18~17.91) 21.39(5.29~105.52) Z=-3.588 <0.001
    肝脏弹性值基线(KPA) 8.70(6.50~15.33) 13.40(10.55~19.60) Z=-4.496 <0.001
    下载: 导出CSV

    表  3  AHE-S患者的独立危险因素分析

    指标 B SE P OR 95%CI
    性别 -0.614 0.441 0.164 0.541 0.228~1.285
    抗-HEV-IgM 0.022 0.009 0.012 1.022 1.005~1.039
    GGT -0.005 0.001 0.001 0.995 0.993~0.998
    前白蛋白 -0.009 0.004 0.020 0.991 0.983~0.999
    肌酐 -0.003 0.003 0.348 0.997 0.991~1.003
    INR 0.721 0.682 0.290 2.057 0.540~7.829
    中性粒细胞绝对数 0.396 0.123 0.001 1.486 1.169~1.889
    AFP 0.000 0.001 0.520 0.999 0.999~1.001
    CD4 0.000 0.001 0.650 0.999 0.999~1.002
    肝脏弹性值 0.026 0.023 0.243 1.027 0.982~1.073
    下载: 导出CSV
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