2890例住院的肝硬化患者病因和并发症分析

摘要

Objective To analyze the etiology and complications of patients with liver cirrhosis. Methods Retrospective analysis of etiology and complications of patients with liver cirrhosis was performed with data collected from 2007 to 2016 in the Department of Gastroenterology,Department of Infectious Disease,and Department of Hepatobiliary Surgery in our hospital. Results In total,the data of 2890 patients with liver cirrhosis were collected and analyzed. Among them,cirrhosis caused by chronic hepatitis B was found in 1632 cases(56.5%),alcoholic liver disease in 216 cases(7.5%),chronic hepatitis B and alcoholic liver disease in 475 cases(16.4%),nonalcoholic fatty liver disease in 37 cases(1.3%),autoimmune liver disease in 218 cases (7.5%);Comparing to the data before 2011,the proportion of chronic hepatitis B reduced from 60.22 to 56.5%,alcoholic liver disease increased from 5.3% to 9.0%,and hepatitis C increased from 1.5% to 2.8%;The most common complications of liver cirrhosis in our series were liver cancer in 628 cases(21.7%),spontaneous peritonitis in 596 cases(20.6%),hyponatremia in 539 cases(18.7%),and upper gastrointestinal bleeding in 512 cases(17.7%);Serum levels of sodium in cirrhosis was found to be negatively correlated with Child-Pugh class,and also negatively with the occurrence of mortality,and the morbidity of hepatic encephalopathy,spontaneous bacterial peritonitis and hepatorenal syndrome. Conclusion Although the constituent ratio of HBV is decreasing during the past decade,it is still the leading etiology of liver cirrhosis. Conversely,alcoholic liver disease and hepatitis C virus infection increase. As one of the common complications of liver cirrhosis,hyponatremia is closely associated with the severity of liver disease,and has a poor prognosis. Clinicians should prevent the occurrence of hyponatremia,especially severe hyponatremia according to its causes.%目的 分析住院的肝硬化患者病因和并发症特点.方法 回顾性分析2007~2016年我院消化内科、感染内科、肝胆外科住院的肝硬化患者病因及并发症特点.结果 十年期间在2890例住院的肝硬化患者中,乙型肝炎1632例(56.5%),酒精性肝病216例(7.5%),乙型肝炎合并酒精性肝病475例(16.4%),非酒精性脂肪性肝病37例(1.3%),自身免疫性肝病218例(7.5%),以2011年为界前后年份比较,慢性乙型肝炎由60.2%下降至53.6%,酒精性肝病由5.4%上升至9.0%.丙型肝炎由1.5%上升至2.8%;肝硬化患者主要并发症依次为原发性肝癌628例(21.7%)、自发性腹膜炎596例(20.6%)、低钠血症539例(18.7%)、上消化道出血512例(17.7%);肝硬化患者血钠浓度与Child分级、肝性脑病、自发性腹膜炎、肝肾综合征发生率和病死率均呈负相关.结论 慢性乙型肝炎仍为肝硬化患者主要病因,但不同时期比较其所占比例呈下降趋势,而酒精性肝病、丙型肝炎肝硬化呈上升趋势.低钠血症作为住院的肝硬化患者常见并发症之一,与肝硬化患者病情严重程度相关,且往往预示预后差,临床医师应根据其发生原因预防低钠血症尤其是重度低钠血症的发生.