摘要
目的探讨乙型肝炎患者肝硬化发生相关的危险因素。方法 2009年1月至2010年1月在复旦大学附属中山医院就诊的HBV感染者988例,分为健康恢复组274例,慢性肝炎肝硬化组429例,非肝硬化组285例。采集患者病史、血清学检查、影像学及病理检查资料,比较3组间的一般情况及临床检测数据。统计分析采用SPSS18.0统计软件、STATA11.0统计软件。结果健康恢复组2.2%的患者有乙型肝炎家族史,慢性乙型肝炎患者47.5%有乙型肝炎家族史;健康恢复组中垂直感染率为56.3%,慢性乙型肝炎组中为93.7%,其中非肝硬化组为89.4%,肝硬化组为96.4%,组间比较,差异均有统计学意义。垂直感染为乙型肝炎转为慢性的高危因素,OR值为15.02(95%CI:9.57～23.94);同时也是慢性乙型肝炎发展至肝硬化的高危因素,OR值为3.15(95%CI:1.39～7.45)。慢性乙型肝炎肝硬化患者病程为(44.1±9.5)年,非肝硬化者为(39.3±9.8)年,男性比例为82.5%,也显著高于非肝硬化者的70.2%,且男性慢性乙型肝炎患者病程为(41.7±9.3)年,女性为(45.0±11.4)年。健康恢复组、慢性乙型肝炎非肝硬化组及肝硬化组的各项肝功能指标的差异均有统计学意义。HBeAg阳性患者中HBsAg与HBV DNA呈负相关(r=-0.43);而HBeAg阴性患者中HBsAg与HBV DNA呈正相关(r=0.23)。慢性乙型肝炎肝硬化患者HBsAg超过1000COI占89.5%,显著高于非肝硬化患者的82.1%,OR值为1.86(95%CI:1.18～2.94)。慢性乙型肝炎患者的HBVDNA水平与病程无相关(P=0.21)。肝硬化组HBV DNA水平为(3.20±2.37)lg拷贝/mL,非肝硬化组HBVDNA(2.875±2.68)lg拷贝/mL,但HBV DNA>5lg拷贝/mL的患者比例在肝硬化组为31%,显著低于非肝硬化组的57.2%。结论慢性乙型肝炎患者肝硬化的危险因素有:病程、家族史、垂直感染、男性、HBsAg大于1000COI、HBVDNA等。
Objective To investigate the clinical risk factors related to the cirrhosis development in patients with hepatitis 13 virus infection. Methods A total of 988 participants with hepatitis B virus infection were collected for this study in Zhong Shah Hospital affiliated with Fu Dan University between January 2009 and January 2011. All of them were Chinese Han nationality from Shanghai and its surrounding area. Their information, including hepatitis history, serum test, liver imaging, and liver histology if available, were collected. They were divided into healthy recovered and chronic hepatitis group, the later was subdivided into cirrhotic group and non-cirrhotic group. The general informations and clinical determination datas were compared with statistical analysis by using SPSS 18.0 and STATA 11.0 software. Results （1） The ratio of male/female participants was 736/252, and the average age was 50.8 ±13.2. The numbers of participants in healthy recovered group, non-cirrhotic chronic hepatitis and cirrhotic group were 274, 285, and 429, respectively, and the average ages were 56.7 ± 13.6, 49.2 ± 11.5, and 47.5 ± 13.5, respectively. Chronic hopatitis B （CHB） familial history was found in 2.2% participants of the healthy recovered group and 47. 5% participants of chronic hepatitis group. The vertical infection rates were 56. 3% in healthy recovered group, and 93. 7% in chronic hepatitis group, which have significant difference between them. For chronic hepatitis group, the vertical rates of non-cirrhotic and cirrhotic group were 89.4G and 96.4G, respectively, which also have significant difference between them. The vertical infection was a risk factor for chronicity of hepatitis B （OR = 15.02, 95% CI：9.57-23.94） and the development of cirrhosis （OR = 3. 15, 95% CI：I. 39 7.45）. The duration of disease of cirrhotic patients （44.1 ± 9.5 years） was longer than that of non cirrhotic CHB patients （39.3 ± 9.8 years）. The ratio of male patients in cirrhotic group was also significantly higher than that in noncirrhotic group （70.2%） and the duration of disease for male patients （41.7 ± 9.3 years） were shorter than that of female patients （45.0 ± 11.4 years）. （2） The levels of liver function rests were significantly different among healthy recover, non- cirrhotic, and cirrhotic group of CHB patients. There were negative correlation between HBsAg and HBV DNA in HBeAg positive patients （r= -0. 43） ; However positive correlation in HBeAg negative patients （r= 0.23） was observed. HBsAg level, which was higher than 1 000 COI, of cirrhotic patients （89.5G） was significant higher than that of non-cirrhotic patients （89.5 %） （OR = 1.86, 95 % CI：I. 18-2.94）. No correlation was found betweem HBV DNA level and the duration of disease of CHB （P = 0. 21）. Although HBV DNA level in cirrhotic group was significantly higher than that in non cirrhotic group （2. 875 ± 2.68 logl ceopies/mL）, the ratio of patients with HBV DNA level, which was higher than 5 log10 copies/mL in cirrhotic group （31%） was significantly lower than that in non-cirrhotic group（57.2%）. Conclusion The factors associated with cirrhosis development in CHB patients include duration of diseases, familial history, route of infection （vertical infection）, male gender, the level of HBsAg（higher than 1 000 COI）, and HBV DNA level.
出处
《肝脏》
2013年第4期211-215,共5页
Chinese Hepatology
关键词
乙型肝炎
肝硬化
危险因素
Chronic hepatitis B
Liver cirrhosis
Risk factors
