20例非酒精性脂肪性肝硬化的临床特征分析

Clinical features of cirrhosis due to nonalcoholic steatohepatitis

目的探讨非酒精性脂肪性肝硬化的临床特征。方法回顾性分析20例非酒精性脂肪性肝硬化初治住院患者的临床资料,以30例乙型肝炎肝硬化初治住院患者作为对照,记录患者性别、年龄、血糖、血脂、白细胞、血小板、凝血酶原活动度、凝血酶原国际标准化比率、总胆红素、白蛋白、胆碱脂酶、尿素氮、肌酐、电解质(血钾、钠、氯)、腹部超声及胃镜等临床数据,计算MELD评分,比较两组间的差异。结果非酒精性脂肪性肝硬化组平均年龄为(69.15±13.84)岁,明显高于对照组[(48.67±15.09)岁,P=0.021];男性占35%(7/20),女性占65%(13/20),对照组男性占80%(24/30),女性占20%(6/30);高血压、糖尿病及血脂紊乱的发病率分别为60%(12/20)、75%(15/20)和55%(11/20),明显高于对照组(分别为16.7%、46.7%和10%,P=0.008、0.015、0.041);凝血酶原活动度为(75.26±8.57)%,明显高于对照组[(52.37±10.86)%,P=0.038],凝血酶原国际标准化比率为1.03±0.25,显著低于对照组(1.44±0.31,P=0.042);电解质紊乱占5%(1/20),明显低于对照组63.3%(19/30,P=0.023);MELD评分为7.69±3.46,显著低于对照组(16.54±9.50,P=0.002)。结论非酒精性脂肪性肝硬化的临床特征为年龄大、女性多见、高血压、糖尿病、血脂紊乱等合并症发病率高,肝功能储备及肾脏功能较好、电解质紊乱少见,预后相对良好,脾功能亢进、食管静脉曲张、腹水等门脉高压表现与乙型肝炎肝硬化相似。

Objective This study aims to investigate the clinical features of cirrhosis due to nonalcoholic steatohepatitis.Methods Clinical data of twenty patients diagnosed as cirrhosis due to nonalcoholic steatohepatitis was retrospectively analyzed and compared with thirty patients diagnosed as cirrhosis due to hepatitis B.The index including gender,age,blood sugar,blood fat,WBC,platelet,PTA%,INR,TBil,albumin,choline phospholipid,urea nitrogen,creatinine,electrolyte,AFP,abdomen ultrasound and gastroscopy report was recorded.MELD score was calculated.The difference of data between two groups was compared.Results The average age in the group of cirrhosis due to nonalcoholic steatohepatitis is（69.15±13.84） years,which is older than that in control group [（48.67±15.09）years,P=0.021].Male accounts 35%（7/20）and female accounts 65%（13/20）,while in control group male accounts 80%（24/30）and female accounts 20%（6/30）.Morbidity of hypertension,diabetes and hyperlipemia is higher than that in control group（respectively 60%vs 16.7%,75%vs 46.7%,55%vs 10%,P=0.008,0.015,0.041）.PTA% is significantly higher than that in control group [（75.26±8.57）% vs（52.37±10.86）%,P=0.038）].INR was obviously lower than that in control group [（1.03±0.25） vs（1.44±0.31）,P=0.042].Incidence of electrolyte disturbances was 5%（1/20）,which is significantly lower than that in control group 63.3%（19/30,P=0.023）.MELD score is obviously lower than that in control group [（7.69±3.46） vs（16.54±9.50）,P=0.002].Conclusion The clinical features of cirrhosis due to nonalcoholic steatohepatitis were listed as following：（1）older age;（2）more common in female than male;（3）higher morbidity due to hypertension,diabetes and hyperlipemia;（4）better liver function and kidney function;（5）less such complications as electrolyte disturbances and hepatorenal syndrome;（6）better prognosis;（7）portal hypertension manifestations such as hypersplenism,EV and ascitis are similar to cirrhosis due to hepatitis B.