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兰州地区肝硬化的病因构成及临床特征分析
Etiologies and clinical features of liver cirrhosis in Lanzhou, China
文章发布日期:2020年04月10日  来源:  作者:沈自雄,李敏,张嵴明,等  点击次数:279次  下载次数:67次

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【摘要】:目的 探讨兰州地区肝硬化患者病因构成及临床特征,分析肝硬化并发原发性肝癌的危险因素。 方法 回顾性分析2015年4月-2018年4月兰州大学第一医院感染科诊治的3496例肝硬化患者病历资料,包括性别、年龄、家族史、既往史、个人史,以及病因、临床表现、并发症、实验室检查结果等。计数资料组间比较采用χ2检验,肝硬化并发肝癌的危险因素分析采用多元logistic回归分析。结果 3496例肝硬化患者中乙型肝炎2209例(63.19%)[2209例患者中有2032例HBeAg信息完整,2032例患者中HBeAg阳性807例(39.71%),HBeAg阴性1225例(60.29%);2209例患者中有2207例有HBV DNA信息,HBV DNA阳性1567例(71.00%)]。丙型肝炎309例(8.84%),自身免疫性肝炎144例(4.12%),原发性胆汁性胆管炎133例(3.80%),酒精性93例(2.66%),隐源性肝硬化447例(12.79%)。主要临床表现为脾大和(或)血细胞减少症2299例(65.76%)、腹水1760例(50.34%)、食管静脉曲张1647例(47.11%)、胃底静脉曲张1386例(39.66%)、黄疸754例(21.57%)。主要并发症为原发性肝癌937例(26.80%)、消化道出血822例(23.51%)、并发感染697例(19.94%)[(肺部感染为主,487例(13.93%)],肝性脑病261例(7.47%)。乙型肝炎肝硬化并发原发性肝癌发生率高于酒精性肝炎肝硬化(χ2=26.854,P<0.001);酒精性肝硬化消化道出血发生率高于乙型肝炎肝硬化(χ2=5.031,P=0.025);乙型肝炎肝硬化肝性脑病发生率低于酒精性肝硬化(χ2=40.903,P<0.001)。确诊原发性肝癌患者中AFP阳性占73.22%,阴性占26.78%。年龄[比值比(OR)=1.025, 95%可信区间(95%CI):1.017~1.034]、男性(OR=2.701, 95%CI: 2.168~3.365)、HBV DNA阳性(OR=1.361, 95%CI:1.123~1.649)、高血压(OR=2.372, 95%CI: 1.845~3.050)、肝癌家族史(OR=2.261, 95%CI:1.255~4.075)是肝硬化并发原发性肝癌的危险因素(P值均<0.05)。结论 兰州地区肝硬化患者最主要的病因为乙型肝炎,其次为丙型肝炎及自身免疫性肝病;主要临床表现为脾大和(或)血细胞减少症,主要并发症为原发性肝癌。积极抗病毒治疗、防治高血压有助于降低肝硬化并发原发性肝癌的风险。
【Abstract】:Objective To investigate the etiologies and clinical features of patients with liver cirrhosis in Lanzhou, China and the risk factors for liver cirrhosis with primary liver cancer. Methods A retrospective analysis was performed for the medical records of 3496 patients with liver cirrhosis who were diagnosed and treated in Department of Infectious Diseases, The First Hospital of Lanzhou University, from April 2015 to April 2018, including sex, age, family history, past history, personal history, etiology, clinical manifestation, complication, and laboratory examination. The chi-square test was used for comparison of categorical data between groups, and the multivariate logistic regression analysis was used to investigate the risk factors for liver cirrhosis with liver cancer. Results Among the 3496 patients with liver cirrhosis, 2209 (63.19%) had hepatitis B, among whom 2032 patients had complete HBeAg data, with 807 (39.71%) HBeAg-positive patients and 1225 (60.29%) HBeAg-negative patients; among these 2209 patients, 2207 had HBV DNA data, among whom 1567 (71.00%) had positive HBV DNA. There were 309 patients (8.84%) with hepatitis C, 144 patients (4.12%) with autoimmune hepatitis, 133 patients (3.80%) with primary biliary cholangitis, 93 patients (2.66%) with alcoholic cirrhosis, and 447 patients (12.79%) with cryptogenic cirrhosis. Major clinical manifestations included splenomegaly and/or hemocytopenia in 2299 patients (65.76%), ascites in 1760 patients (50.34%), esophageal varices in 1647 patients (47.11%), gastric varices in 1386 patients (39.66%), and jaundice in 754 patients (21.57%). The main complications included primary liver cancer in 937 patients (26.80%), gastrointestinal bleeding in 822 cases (23.51%), infection in 697 patients (19.94%) [mainly pulmonary infection in 487 patients (13.93%)], and hepatic encephalopathy in 261 patients (7.47%). The patients with hepatitis B cirrhosis had a significantly higher incidence rate of primary liver cancer than those with alcoholic hepatitis cirrhosis (χ2=26.854, P<0.001); the patients with alcoholic cirrhosis had a significantly higher incidence rate of gastrointestinal bleeding than those with hepatitis B cirrhosis (χ2=5.031, P=0.025); the patients with hepatitis B cirrhosis had a significantly lower incidence rate of hepatic encephalopathy than those with alcoholic cirrhosis (χ2=40.903, P<0.001). Among the patients with a confirmed diagnosis of primary liver cancer, 73.22% had positive alpha-fetoprotein (AFP) and 26.78% had negative AFP. Age (odds ratio [OR]=1.025, 95% confidence interval [CI]: 1.017-1.034, P<0.05), male sex (OR=2.701, 95% CI: 2.168-3.365, P<0.05), positive HBV DNA (OR=1.361, 95% CI: 1.123-1.649, P<0.05), hypertension (OR=2.372, 95% CI: 1.845-3.050, P<0.05), and a family history of liver cancer (OR=2.261, 95% CI: 1.255-4.075, P<0.05) were risk factors for primary liver cancer in patients with liver cirrhosis. Conclusion Hepatitis B is the main etiology of liver cirrhosis in Lanzhou, followed by hepatitis C and autoimmune liver disease. The main clinical manifestations are splenomegaly and/or hemocytopenia, and the main complication is primary liver cancer. Active antiviral therapy and prevention of hypertension may help to reduce the risk of primary liver cancer in patients with liver cirrhosis.
【关键字】:肝硬化; 肝肿瘤; 疾病特征; 危险因素
【Key words】:liver cirrhosis; liver neoplasms; disease attributes; risk factors
【引证本文】:SHEN ZX, LI M, ZHANG JM, et al. Etiologies and clinical features of liver cirrhosis in Lanzhou, China[J]. J Clin Hepatol, 2020, 36(4): 783-787. (in Chinese)
沈自雄, 李敏, 张嵴明, 等. 兰州地区肝硬化的病因构成及临床特征分析[J]. 临床肝胆病杂志, 2020, 36(4): 783-787.

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