2002例肝硬化患者的病因及并发症分析

Survey of 2002 cases of liver cirrhosis: Identification of etiological factors and related complications

目的探讨近年重庆医科大学附属第二医院肝硬化病因及并发症特点。方法回顾性分析本院2002年1月-2011年12月2002例肝硬化住院患者病因及相关资料。计数资料以百分数表示,不同组间率的比较采用χ2检验。结果病因构成方面,乙型肝炎1213例(60.6%),酒精性脂肪肝133例(6.6%),乙型肝炎合并酒精性脂肪肝332例(16.6%),自身免疫性肝病136例(6.7%),非酒精性脂肪肝34例(1.7%)。以2007年1月1日为界,将时期分为前后两段比较分析,显示乙型肝炎肝硬化人数构成比由64.1%下降到59.3%(P<0.05),乙型肝炎合并酒精性肝硬化由13.6%增至17.7%(P<0.05),自身免疫性肝硬化由3.5%增至7.1%(P<0.05)。肝硬化主要并发症发生率依次为原发性肝癌(22.1%)、自发性腹膜炎(21.3%)、上消化道出血(19.3%)、肝性脑病(7.3%)、肝肾综合征(4.0%)。有乙型肝炎家族史的肝硬化患者肝癌发生率明显高于无家族史者(31.1%vs.22.2%,P<0.05),高HBV载量的肝硬化患者肝癌发生率也明显增加(χ2=10.88,P<0.05)。结论乙型肝炎仍然是我院肝硬化主要病因,但酒精因素及自身免疫性肝病所致肝硬化明显增加,原发性肝癌为肝硬化最常见并发症,乙型肝炎合并酒精性肝硬化的预后最差。

Objective To identify the etiologies and associated complications of liver cirrhosis for new cases emerging over the past decade in the region served by the Second Affiliated Clinical College of Chongqing University of Medical Sciences.Methods The institute′s inpatient medical record database was searched for all individuals admitted with a new diagnosis of liver cirrhosis between January 2002 and December 2011.Data on demographics and clinical findings were collected for retrospective analysis to determine the regional and temporal profiles of etiologies and complications.The count data,expressed as percent of total,was analyzed by the Chi-squared test.Results Among the total 2002 liver cirrhosis cases,the most frequent etiologies（1.5% of total） were viral hepatitis type B（60.6%）,fatty liver caused by both hepatitis B virus（HBV） and alcohol（16.6%）,alcoholic fatty liver（6.6%）,autoimmune liver disease（3.4%）,autoimmune liver disease and alcohol（3.2%）,and nonalcoholic fatty liver（1.7%）.From the first half of the decade to the second half（January 2002-December 2006 vs.January 2007-December 2011）,the incidences of two etiologies significantly increased（HBV and alcohol： 13.6% vs.17.7%,P0.05 and autoimmune liver disease： 3.5% vs.7.1%,P0.05） and the incidence of HBV significantly decreased（64.1% vs.59.3%,P0.05）.The most common major complications of cirrhosis were primary hepatocellular carcinoma（HCC;22.1%）,spontaneous peritonitis（21.3%）,upper gastrointestinal bleeding（19.3%）,hepatic encephalopathy（7.3%）,and hepatorenal syndrome（4.0%）.The incidence of liver cancer was significantly higher in patients with a family history of hepatitis B（31.1% vs.22.2%,P0.05） and positively correlated with HBV DNA load（χ2 = 10.88,P0.05）.Conclusion In Chongqing,HBV remains a major cause of cirrhosis,even though alcoholism and autoimmune disease are rising in importance as etiological factors,and HCC is still the major complication of liver cirrhosis.The public health strategies in this region should continue to target prevention of HBV infection and diagnosis/treatment of HCC in early stages.