236例急性戊型肝炎的临床特征及危险因素分析

摘要

Objective To investigate the clinical features of acute hepatitis E (AHE) and the risk factors for severe jaundice and liver failure.Methods In the retrospective study,a total of 236 patient with AHE in our hospital from 2011 to 2014 were enrolled.To analyze risk factors for severe jaundice with AHE,patients were divided into 4 groups according to total bilirubin (TBil) levels (Group 1:TBil＜34 μmol/L,Group 2:34 ≤ TBil＜85 μmol/L,Group 3:85 ≤ TBil＜170 μmol/L,Group 4:TBil ≥ 170 μmol/L).Additionally,patients with severe jaundice (TBil ≥ 170 μmol/L) were divided into liver failure group and non-liver failure group according to the prothrombin time activity (PTA ≤ 40％) for analyzing the risk factors for hepatitis E virus (HEV)-induced liver failure.Results Severe jaundice tended to occur in elderly male patients (P＜0.01).Patients with history of alcohol and biliary stone showed higher level of bilirubin (P＜0.05).Meanwhile,high level of bilirubin was associated with white blood cell (WBC),blood platelet (PLT) and pre-albumin.Furthermore,patients with cirrhosis,biliary stone or infection were significantly increased in liver failure group (P＜0.05).Cirrhosis was a risk factor for HEV-induced liver failure.Conclusion Several factors were involved in the progression of AHE.Cirrhosis,biliary stone and bacterial infection were risk factors for AHE-induced liver failure.%目的 分析急性戊型病毒性肝炎(AHE)的临床特征及促使黄疸加重及肝衰竭的危险因素.方法 回顾性分析2011年至2014年连续收治的AHE患者236例,收集患者的病史、血清学、影像学等临床资料.根据血清TBil水平将患者分为4组:TBil＜34 μmol/L,34≤TBil＜85μmol/L,85≤TBil＜170 μmol/L,TBil≥170 μmol/L,分析AHE黄疸加重的影响因素.在重度黄疸(TBil≥170μmol/L)的AHE患者中,根据是否存在凝血酶原时间延长(PTA≤40％),分为肝衰竭组和非肝衰竭组,分析肝衰竭的危险因素.结果 老年及男性戊型肝炎患者易出现重度黄疸(P＜0.01);存在饮酒史以及合并感染及胆道系统结石者,黄疸水平较高(P＜0.05);同时,高胆红素水平还与白细胞、血小板、前白蛋白等指标密切相关.进一步的研究发现,肝衰竭组中存在肝硬化基础的患者,以及合并感染及胆道系统结石者比例显著升高(P＜0.05).Logistic回归分析显示,肝硬化基础是戊型肝炎肝衰竭的危险因素.结论 多重因素参与AHE的重症化过程.存在肝硬化基础,合并胆道结石及感染的AHE患者易发生肝衰竭.