621例急性戊型肝炎流行病学及临床特征研究

摘要

Objective To investigate the epidemiological and clinical features of acute hepatitis E (AHE).Methods All the data of AHE patients from April 2005 to October 2011 were collected and their epidemiological features were retrospectively analyzed.Patients were divided into two groups:patients with single hepatitis E virus (HEV ) infection and patients with HEV/hepatitis B virus (HBV ) coinfection,to compare the biochemical parameters and outcomes and to find out the risk factors for AHE related liver failure.Kruskal-Wallis test,Chi square test,and Logistical regression analysis were used for statistical analysis.Results A total of 621 cases were included in the present study and most patients were elderly male and happened from February to May every year.The incidence of AHE related liver failure and mortality was 18.68% and 1 .93%,respectively.Compared to the single HEV group (n=331 ),the HEV/HBV group (n = 280 )had a longer hospital stay (46 d vs 40 d,Z = - 4.591 ,P < 0.01 ),a significantly lower prothrombin activity (55 .5 % vs 78.7%,Z =-7.998,P <0.01 )and a significantly higher incidence of AHE related liver failure (30.7% vs 9.1 %,χ2 =46.229,P <0.01 ).In single HEV related liver failure group (n=30),the percentages of early-stage,interim-stage and end-stage live failure were 53.33%,23.33% and 23.33%,respectively.While in the HEV/HBV related liver failure group (n=86),the corresponding numbers were 34.88%,31 .40% and 33.72%,respectively.The differences were not statistically significant (χ2 = 3.176,P = 0.204 ).Additionally,the clinical outcome between these two groups was also comparable (83.33% vs 91 .86%,χ2 =0.945 ,P = 0.331 ).The Logistic analysis showed that age over 50 years (OR=2.080,P =0.002)and coinfection with HBV (OR=5 .632, P <0.01)were risk factors for AHE related liver failure.Conclusions AHE is seasonal and mainly occurs in elderly male.Advanced age and HBV coinfection may be risk factors of severe AHE.%目的：探讨急性戊型肝炎（AHE）流行病学与临床特征。方法收集2005年4月至2011年10月收治 AHE 患者资料，回顾性分析其流行病学特征，并将患者分为单纯 HEV 组与 HEV/HBV重叠感染组，比较生物化学指标、临床转归，分析 AHE 相关肝衰竭危险因素。行 Kruskal-Wallis 检验、χ2检验和 Logistic 回归分析。结果共621例 AHE 患者纳入本研究，发病高峰为每年2至5月，病例主要为中老年男性，AHE 相关肝衰竭发生率为18．68％，病死率为1．93％。与单纯 HEV 感染患者（331例）比较，HEV/HBV 重叠感染患者（280例）住院时间长（46 d 比40 d，Z ＝-4．591，P ＜0．01）， PTA 明显下降（55．5％比78．7％，Z ＝-7．998，P ＜0．01），且 AHE 相关肝衰竭发生率明显升高（30．7％比9．1％，χ2＝46．229，P ＜0．01）。单纯 HEV 感染肝衰竭患者（30例）早期、中期与晚期构成比分别为53．33％、23．33％、23．33％，HEV/HBV 重叠感染肝衰竭患者（86例）则为34．88％、31．40％、33．72％，两组间分期的差异无统计学意义（χ2＝3．176，P ＝0．204）。单纯 HEV 感染肝衰竭与 HEV/HBV 重叠感染肝衰竭患者好转率的差异无统计学意义（83．33％比91．86％，χ2＝0．945，P ＝0．331）。Logistic 回归分析提示，患者年龄＞50岁（OR＝2．080，P ＝0．002）及重叠感染 HBV（OR ＝5．632，P ＜0．01）为预测AHE 相关肝衰竭的危险因素。结论AHE 存在季节性，且主要为中老年男性患者，老年及重叠感染HBV 为 AHE 重症化发生的危险因素。