1260例重型肝炎治疗研究

Clinical experience in the treatment of 1260 patients with severe hepatitis

目的 为进一步提高重型肝炎的存活率。方法 分析近20年收治的1260例各型重型肝炎的疗效及影响预后的因素。结果 重型肝炎以乙型肝炎发病率最高,占89.36％。慢性重型肝炎占80.48％。急性亚急性重型肝炎存活率明显高于慢性肝炎(P<0.001)。患者早、中、晚期接受治疗的存活率分别为82.77％、60.48％、14.35％(P<0.001)。血清胆红素浓度与病死率成正相关。凝血酶原活动度(PTA)是判断重型肝炎预后的重要指标,PTA值超低死亡率越高。甲胎蛋白(AFP)上升提示肝细胞增生活跃,预后较好。重型肝炎发生的并发症越多者死亡率越高。结论 重型肝炎应早期诊断,早期采用综合性治疗方案及应用人工肝治疗,预防和减少各种并发症,是提高存活率的有效措施。

Objective To increase the survival rate of patients with severe hepatitis. Methods The survival rate and the related influencing factors were analyzed in 1260 patients with severe hepatitis treated in our hospital in recent twenty years. Results Among the patients with severe hepatitis observed, 89. 36% were infected by HBV and 80. 48% were classified as chronic severe hepatitis. The survival rates in acute and subacute groups were much higher than that in chronic group(P<0. 001). The survival rates in early, middle and late stage were 82. 77%, 60. 48% and 14. 35%, respectively. There was a positive correlation between the value of serum bilirubin and the death rate. The negative correlation could be found between the activity of prothrombin (PTA) and the death rate. Alpha fetoprotein (AFP) value in the survival group was much higher than that in death group (P<0. 001). More complications happened in the death group than that in the survival group (P< 0. 001). Conclusions Early diagnosis , applying combined therapies including artificial liver support system and preventing the occurrence of complications can improve the survival rate of the patients with severe hepatitis.