282例散发性戊型肝炎流行病学及临床特征分析

Epidemiological and clinical characteristics of sporadic hepatitis E:A report of 282 cases

目的探讨现阶段散发性戊型肝炎流行病学及临床特征,为新的流行趋势下戊型肝炎的临床诊治提供依据。方法收集我科2003年6月至2008年7月散发性戊型肝炎282例,回顾性分析病原学特征、发病年龄、流行季节、症状、体征以及临床生化指标,比较单纯戊型肝炎(单纯组)和戊型重叠乙型肝炎(重叠组)的临床特征及重症化差异。结果 282例患者中重叠组占35.5%,各年龄段均有发病,男女比例约3∶1,单纯组以35-60岁年龄段为主(60.7%),单纯组年龄显著高于重叠组(P<0.001)。本病各季节均有发病,单纯组好发于春夏季节(74.5%),重叠组呈季节散发态势。乏力(83.4%)、纳差(82.8%)、皮肤巩膜黄染(75.9%)是患者首要症状,73.4%的患者DBIL/TBIL比值大于0.5,呈现胆汁淤积。男性患者皮肤巩膜黄染率、胆红素水平及DBIL/TBIL比值,显著高于女性(P<0.05)。重叠组球蛋白、凝血酶原时间、重型肝炎发生率显著高于单纯组(P值分别为0.001、0.001、2.0×10-4)。结论与暴发性戊型肝炎相比,散发性戊型肝炎的季节性及年龄分布发生变化,重叠感染多见;男性及老年患者存在更严重的胆汁淤积和肝功能损伤;重叠HBV感染患者肝损害重,容易发展为重型肝炎。重视老年及有肝病基础的戊型肝炎患者的诊治,是降低戊型肝炎及其重型发病率的重要环节。

Objective To provide the evidence for the diagnosis and treatment of sporadic hepatitis E（HE） by studying its epidemiological and clinical characteristics in recent years.Methods Epidemiological and clinical characteristics of sporadic HE including etiology,age of disease onset,epidemic season,symptoms,and signs,and other clinical biochemical indications of 282 sporadic HE patients admitted to our institute from March 2003 to July 2008 were retrospectively analyzed.Differences in clinical characteristics and severity between HE patients without HBV superinfection（simple HE group） and those with HBV superinfection（HBV superinfection group） were compared.Results The HE patients with HBV superinfection accounted for 35.5% of the 282 HE patients.The disease occurred at different ages of the patients and mainly occurred in patients of simple HE group at the age of 35-60 years（accounting for 60.7%）.The male and female ratio was 3：1,which was significantly higher in simple HE group than in HBV superinfection group（P〈0.001）.The disease occurred in differents seasons.Simple HE mainly occurred in Spring and Summer（accounting for 74.5%）,and HE with HBV superinfection occurred sporadically in different seasons.The most common symptoms of the patients were fatigue,anorexia,and jaundice,which were observed in 83.4%,82.8%,and 75.9 % of the patients.The ratio of total bilirubin（TBIL）/direct bilirubin（DBIL） was greater than 0.5 in 73.4% of the patients,indicating that cholestasis can be diagnosed in these patients.The incidence of skin and sclera jaundice,the serum bilirubin level and the DBIL/TBIL ratio were significantly higher in male patients than in female patients（P〈0.05）.The serum albumin（Alb） level,prothrombin time（PT）,and the incidence of severe HE were significantly higher in HBV superinfection group than in simple HE group（t=3.221,P=0.001;t=3.330,P=0.001;Chi-squar=13.168,P=2.0×10-4）.Conclusion The indicence of HE with HBV superinfection is higher than that of fulminant HE.The incidence of sporadic HE varies with seasons and age of patients.Cholestasis and liver function impairment are more severe in male and old HE patients than in female and young HE patients.Liver damage is severe in HE patients with HBV superinfection,which can progress to severe hepatitis.Importance should be attached to the diagnosis and treatment of HE in old patients.