151例亚急性重型肝炎患者临床特征与预后分析

Clinical features and prognosis of 151 cases with subacute severe hepatitis

目的分析151例亚急性重型肝炎的临床特征及其预后。方法应用SPSS 10.0及STATA软件对151例亚急性重型肝炎病人的临床特征进行回顾性分析。结果(1)亚急性重型肝炎男性发病高于女性,好发年龄>40岁;(2)亚急性重型肝炎病原仍以乙型肝炎病毒为主,其次为戊型肝炎病毒及不明原因,药物性以抗结核药物为主;(3)实验室指标TB、PT、PTR、WBC及其分类、BLA、CRE与预后成正相关,与PTA、TC、ALB、CHE、TG、PLT成负相关,与ALT、AST无相关性;(4)并发症发生率最高前3位为电解质紊乱、肝性脑病、自发性腹膜炎,病死率最高前三位为脑疝、肝肾综合征和脑水肿。结论亚急性重型肝炎好发于男性,好发年龄段为40岁以上;仍以乙型肝炎病毒为主要病原;电解质紊乱是最主要的并发症,肝性脑病发病不足50%;PT、TB、PLT、TC、ALB等可作为肝衰竭(亚急性重型肝炎)预后判断的独立指标。对于无肝性脑病的亚急性重型肝炎患者,严重的凝血功能异常是一个重要的灵敏和特异性指标。

Objective To analyze the clinical features and prognosis of 151 patients with subacute severe hepatitis （SSH）. Methods The clinical features of 151 patients with SSH were retrospectively analyzed by SPSS 10.0 and STATA software. Results 1. The incidence of SSH in males is higher than that in females,and most of cases are more than 40 years old;2 HBV is still the main pathogen of SSH ,the next is HEV and unknown pathogens. In drug - induced SSH, anti - tuberculosis medicines are the main ones ; 3. TB, PT, ErR, WBC and polymorphocytes in differential cell count, BLA, CRE were positively related to prognosis. However, phosphotransacetylase （ PTA）, TC, ALB, CHE, TG, PLT were negatively related to prognosis. The relations of ALT, AST and prognosis were observed. The commonest complications were unbalance of electrolyte, hepatic encephalopathy （41.7%） and spontaneous bacterial peritonitis. The commonest complications associated with high mortality were herniation, hepatorenal syndrome and cerebral edema. The degree of HE was negatively correlated with prognosis;the incidence of ascites is 54.3%. The PT were more than 30s and PTA were less than 30% when the patients occurred HE or when SSH were diagnosed in SSH patients. Conclusions SSH more frequently affects males and the patients over 40 years old;its main cause is HBV infection followed by drug induction. PT,TB,PLT,TC,ALB etc can be the independent predicators in judging the prognosis of liver failure. The severe abnormalities in the function of blood coagulation is an important and sensitive markers in the SSH patients without HE.