2002例肝硬化患者的病因及并发症分析

艾敏; 陈伟婵; 沈薇

2002例肝硬化患者的病因及并发症分析

1. 重庆医科大学附属第二医院消化内科
2. 广东医学院附属医院特需病区

详细信息

中图分类号: R575.2
计量
- 文章访问数: 2513
- HTML全文浏览量: 12
- PDF下载量: 668
- 被引次数: 0
出版历程
- 出版日期: 2013-05-20

Survey of 2002 cases of liver cirrhosis: Identification of etiological factors and related complications

摘要

摘要:
目的探讨近年重庆医科大学附属第二医院肝硬化病因及并发症特点。方法回顾性分析本院2002年1月-2011年12月2002例肝硬化住院患者病因及相关资料。计数资料以百分数表示,不同组间率的比较采用χ2检验。结果病因构成方面,乙型肝炎1213例（60.6%）,酒精性脂肪肝133例（6.6%）,乙型肝炎合并酒精性脂肪肝332例（16.6%）,自身免疫性肝病136例（6.7%）,非酒精性脂肪肝34例（1.7%）。以2007年1月1日为界,将时期分为前后两段比较分析,显示乙型肝炎肝硬化人数构成比由64.1%下降到59.3%（P<0.05）,乙型肝炎合并酒精性肝硬化由13.6%增至17.7%（P<0.05）,自身免疫性肝硬化由3.5%增至7.1%（P<0.05）。肝硬化主要并发症发生率依次为原发性肝癌（22.1%）、自发性腹膜炎（21.3%）、上消化道出血（19.3%）、肝性脑病（7.3%）、肝肾综合征（4.0%）。有乙型肝炎家族史的肝硬化患者肝癌发生率明显高于无家族史者（31.1%vs.22.2%,P<0.05）,高HBV载量的肝硬化患者肝癌发生率也明显增加（χ2=10.8...
- 肝硬化 /
- 肝炎,乙型 /
- 癌,肝细胞
Abstract:
Objective To identify the etiologies and associated complications of liver cirrhosis for new cases emerging over the past decade in the region served by the Second Affiliated Clinical College of Chongqing University of Medical Sciences.Methods The institute′s inpatient medical record database was searched for all individuals admitted with a new diagnosis of liver cirrhosis between January 2002 and December 2011.Data on demographics and clinical findings were collected for retrospective analysis to determine the regional and temporal profiles of etiologies and complications.The count data, expressed as percent of total, was analyzed by the Chi-squared test.Results Among the total 2002 liver cirrhosis cases, the most frequent etiologies (>1.5% of total) were viral hepatitis type B (60.6%) , fatty liver caused by both hepatitis B virus (HBV) and alcohol (16.6%) , alcoholic fatty liver (6.6%) , autoimmune liver disease (3.4%) , autoimmune liver disease and alcohol (3.2%) , and nonalcoholic fatty liver (1.7%) .From the first half of the decade to the second half (January 2002-December 2006 vs.January 2007-December 2011) , the incidences of two etiologies significantly increased (HBV and alcohol: 13.6% vs.17.7%, P<0.05 and autoimmune liver disease: 3.5% vs.7.1%, P<0.05) and the incidence of HBV significantly decreased (64.1% vs.59.3%, P<0.05) .The most common major complications of cirrhosis were primary hepatocellular carcinoma (HCC;22.1%) , spontaneous peritonitis (21.3%) , upper gastrointestinal bleeding (19.3%) , hepatic encephalopathy (7.3%) , and hepatorenal syndrome (4.0%) .The incidence of liver cancer was significantly higher in patients with a family history of hepatitis B (31.1% vs.22.2%, P<0.05) and positively correlated with HBV DNA load (χ2 = 10.88, P<0.05) .Conclusion In Chongqing, HBV remains a major cause of cirrhosis, even though alcoholism and autoimmune disease are rising in importance as etiological factors, and HCC is still the major complication of liver cirrhosis.The public health strategies in this region should continue to target prevention of HBV infection and diagnosis/treatment of HCC in early stages.
- liver cirrhosis /
- heapatitis B /
- carcinoma

HTML全文

参考文献(19)

[1]Chinese Society of Infectious Diseases and Parasitology and ChineseSociety of Hepatology, Chinese Medical Association.Prevention andtreatment of viral hepatitis[J].Chin J Hepatol, 2000, 8 (6) :324-329. (in Chinses) 中华医学会传染病与寄生虫病学分会、肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志, 2000, 8 (6) :324-329.

[2] Chinese Society of Hepatology and Chinese Society of Infectious Dis-eases, Chinese Medical Association.The guideline of preventionand treatment for chronic hepatitis B (2010 version) [J].J ClinHepatol, 2011, 27 (1) :Ⅰ-ⅩⅥ. (in Chinese) 中华医学会肝病学分会、感染病学分会.慢性乙型肝炎防治指南 (2010年版) [J].临床肝胆病杂志, 2011, 27 (1) :Ⅰ-ⅩⅥ.

[3]Chinese Society of Hepatology and Chinese Society of Infectious Dis-eases and Parasitology, Chinese Medical Association.Guidelines forprevention and treatment of hepatitis C[J].Clin Hepatol, 2004, 12 (4) :197-203. (in Chinses) 中华医学会肝病学分会、传染病与寄生虫病学分会.丙型肝炎防治指南[J].临床肝胆病杂志, 2004, 12 (4) :197-203.

[4] Fatty Liver and Alcoholic Liver Disease Study Group of the ChineseLiver Disease Association, Chinese Medical Association.Guidelinesfor diagnosis and treatment of alcoholic liver disease (revised version2010) [J].J Clin Hepatol, 2010, 26 (3) :229-232. (in Chins-es) 中华医学会肝病学分会脂肪肝和酒精性肝病学组.酒精性肝病诊疗指南 (2010年修订版) [J].临床肝胆病杂志, 2010, 26 (3) :229-232.

[5] Fatty Liver and Alcoholic Liver Disease Study Group of the ChineseLiver Disease Association, Chinese Medical Association.Guidelinesfor diagnosis and treatment of nonalcoholic liver disease (revisedversion 2010) [J].J Clin Hepatol, 2010, 26 (2) :120-124. (inChinses) 中华医学会肝病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南 (2010年修订版) [J].临床肝胆病杂志, 2010, 26 (2) :120-124.

[6]Manns MP, Czaja AJ, Gorham JD, et al.Diagnosis and manage-ment of autoimmune hepatitis[J].Hepatology, 2010, 51 (6) :2193-213.

[7]Heathcote EJ.Management of primary biliary cirrhosis.The Ameri-can Association for the Study of Liver Diseases practice guidelines[J].Hepatology, 2000, 31 (4) :1005-1013.

[8]Czaja AJ.Overlap syndrome of primary biliary cirrhosis and autoim-mune hepatitis:a foray across diagnostic boundaries[J].J Hepatol, 2006, 44 (2) :251-252.

[9]Kondili LA, Tosti ME, Szklo M, et al.The relationships of chronichepatitis and cirrhosis to alcohol intake, hepatitis B and C, and del-ta virus infection:a case-control study in Albania[J].EpidemiolInfect, 1998, 121 (2) :391-395.

[10]Chen P, Yan L, Ye DQ, et al.The detection of autoantibody andautoimmune liver disease in patients with abnormal liver function ofunknown etiology[J].Chongqing Med, 2011, 40 (3) :239-241. (in Chinese) 陈瀑, 严立, 叶荻庆, 等.不明原因肝功能异常患者自身抗体的检测及对自身免疫性肝病的临床意义[J].重庆医学, 2011, 40 (3) :239-241.

[11]Farrell GC, Chitturi S, Lau Gk, et al.Guidelines for the assess-ment and management of non-alcoholic fatty liver disease in the A-sia-Pacific region:executive summary[J].J Gastroenterol Hepa-tol, 2007, 22 (6) :775-777.

[12]Hashimoto E, Yatsuji S, Tobari M, et al.Hepatocellular carcinomain patients with nonalcoholic steatohepatitis[J].J Gastroenterol, 2009, 44 (Suppl 19) :89-95.

[13]Kelley DE, Mckolanis TM, Heqazi RA, et al.Fatty liver in type 2diabetes mellitus:relation to regional adiposity, fatty acids, and in-sulin resistance[J].Am J Physiol Endocrinol Metab, 2003, 285 (4) :E906-E916.

[14]Bai XG, Zhang LH, He WG, et al.Epidemiologic and clinical features of546 patients with posthepatitic cirrhosis[J].J Fourth Mil Med Univ, 2000, 21 (7) :820-823. (in Chinese) 白宪光, 张丽环, 何文革.546例肝炎后肝硬化患者的流行病学和临床特点[J].第四军医大学学报, 2000, 21 (7) :820-823.

[15]Chen CJ, Yang HI, Su J, et al.Risk of hepatocellular carcinomaacross a biological gradient of serum hepatitis B virus DNA level[J].JAMA, 2006, 295 (1) :65-73.

[16]Wu L, Su F.Progress in pathogenesis, diagnosis, treatment andprognosis of spontaneous bacterial peritonitis[J].Anhui Med Phar-mac J, 2010, 14 (12) :1380-1383. (in Chinese) 吴玲, 苏菲.自发性细菌性腹膜炎发病机制、诊治、预后进展[J].安徽医药, 2010, 14 (12) :1380-1383.

[17]Zhang WZ.Epidemiological characteristics of cirrhosis patients:ananalysis of 155 cases[J].J Clin Hepatol, 2012, 15 (1) :55-56. (in Chinese) 张文忠, 155例肝硬化患者流行病学特征分析[J].实用肝脏病杂志, 2012, 15 (1) :55-56.

[18]Garcia-Tsao G, Bosch J.Management of varices and variceal hemor-rhage in cirrhosis[J].N Engl J Med, 2010, 362 (9) :823-832.

[19]Szabo G.Pathogenic interactions between alcohol and hepatitis C[J].Curr Gastroenterol Rep, 2003, 5 (1) :86-92.

施引文献

资源附件(0)

访问统计