急性戊型肝炎临床分析221例

A clinical analysis of 221 patients with acute hepatitis E

目的:观察和分析急性戊型肝炎的临床特点.方法:调查急性戊型肝炎患者221例的流行病学资料.分别比较年龄18岁以下、18-60岁和60岁以上患者组,单纯急性戊肝组和重叠慢乙型肝炎、酒精肝组以及单项抗-HEV-IgG阳性组与抗-HEV-IgM阳性组病例的病程、生化学指标、预后等方面的差异.结果:221例急性戊型肝炎患者中18岁以上者188例,占84.8%;男女之比3.92∶1;职业分布特点是外出务工者108例,占48.8%;2-5月份发病患者数占当年发病患者数的67.8%,随患病年龄增加,表现出住院时间延长,病死率增加,ALT、ALB水平呈下降趋势,各组比较均有显著差异.重叠乙型肝炎和酒精肝组的重肝发生率及死亡率分别为7.8%、1.9%和6.0%、3.0%,明显高于单纯戊肝组的2.1%和0.7%.抗-HEV-IgG阳性与抗-HEV-IgM阳性病例的临床表现和各项生化学指标比较无显著性差异.结论:急性戊型肝炎成年人多发,外务工者高发,有冬春发病高峰.大多数患者预后良好,老年戊型肝炎及在乙型肝炎、酒精肝基础上重叠戊肝病毒感染可能是影响患者预后的主要因素.

AIM： To investigate and analyze clinical characteristics of patients with acute hepatitis E infection. METHODS： Epidemiological data of 221 patients with acute hepatitis E infection were collected. Comparisons were performed to find the differences in disease course, biochemical index and prognosis amongst diverse age groups （below 18-years-old, between 18 and 60, above 60）, different status of disease groups （hepatitis E infection only, hepatitis E infection accompanied by hepatitis B infection/alcohol hepatitis）, and different antibody groups （anti-HEV-IgG positive, anti-HEV-IgM positive）. RESULTS： 84.8% （188/221） of patients were over 18 years old, and the ratio of male/female was 3.92∶1. Then the characteristics of occupation distribution were people working outside, 108 patients （48.8%） in this group. In addition, season was another factor that influenced hepatitis E infection, especially from February to May during which there were 67.8% patients infected with hepatitis E. The clinical features were summarized into three points： prolonged disease course, an increased mortality and decreased levels of ALT/ALB were associated with older age. Second, the prevalence of severe liver disease and mortality in the group of hepatitis E infection accompanied by hepatitis B （7.8%, 1.9%） and alcohol hepatitis （6.0%, 3.0%） were higher than those in hepatitis E infection group （2.1%, 0.7%）. In addition, there was no significant difference in clinical symptoms and biochemical indexes between anti-HEV-IgG positive and anti-HEV-IgM positive groups. CONCLUSION： Four epidemiological characteristics, including adult, male, people working outside and winter/spring, are found to be associated with hepatitis E infection. The prognosis of disease in the majority of patients is favorable, old age and coexistence with hepatitis B and alcohol hepatitis can be seen as the factors which affect the prognosis.