病毒性肝炎肝硬变危险因素的5年追踪调查

A five-year follow-up survey of risk factor of viral hepatic cirrhosis

目的探讨肝炎后肝硬变形成的危险因素.方法建立一人一卡,每年随访和门诊检查一次,对贵州省5家医院2250例乙肝患者进行5a 追踪调查及干预对照试验,5a后追踪率达90.28%.调查内容包括性别、年龄、吸烟史、饮酒史、蛋白摄入水平、乙肝家族史、负性因素(即心理因素,如:亲人死亡、意外打击、家庭不和、工作不顺、对疾病的恐惧、焦虑等)及治疗史,采用 X^2检验各种单因素,有显著意义者再分别计算其相对危险度(RR)值及其可信区间(95%CI),观察与肝炎后肝硬变形成相关的危险因素.干预组定期给予预防肝硬变的卫生健康知识强化宣传,提出合理饮食、戒酒及心理咨询、定期服用保肝药等.结果 HBeAg、抗-HBe、HBVDNA(RR 值1.21～9.82)、抗-HCV(RR 值5.50)持续阳性、乙肝家族史(RR 值14.71)、饮酒(RR 值9.82)、低蛋白饮食(RR 值6.64),心理因素(RR 值8.92)与肝硬变形成相关.干预对照试验表明,5a 后干预组肝硬变的发生率10.58%,对照组为22.91%(P<0.05).结论乙肝病毒(HBV)持续复制、合并丙肝病毒(HCV)感染、乙肝家族史、饮酒、低蛋白饮食及心理因素是肝炎后肝硬变形成的危险因素.

AIM To study the risk factors by which the post-hepatic cirrhosis formed. METHODS Follow-up and ambulatory check were made once a year.Five-year follow-up investigation and interference check experiment were performed on 2250 patients with hepatitis B in five hospitals of Guizhou Province,with a follow-up rate of 90.28%.Investigation was made on sex,age,history of smoking,history of drinking,level of protein intake family history of hepatitis B,negative factor(psychological factor,such as the death of relatives,accidental attack,dispute among members of family,unsatisfactory with the work,fear of disease,anxiety,etc)and the history of treatment.Using Chi-square test to test the single factor,if any factor is significant,its relative risk(RR)and its confidence interval(95% CI)were calculated.The risk factors of post-hepatic cirrhosis observed.Propaganda of knowledge on how to prevent hepatic cirrhosis in a fixed time on reasonable diet,quitting drinking and psychological consultiation,and liver-protection medicine. RESULTS Continuous positive HBeAg,anti-HBe, HBVDNA(RR:1.21-9.82),anti-HCV(RR:5.50),and family history with hepatitis B(RR.14.71),drinking(RR: 9.82),low protein diet(RR:6.64)and psychological factor(RR.8.92)were related to the formation of hepatic cirrhosis.The interference check experiment indicated that the incidence of hepatic cirrhosis in interference group after 5 years was 10.58%,and was 22.91% in the control group(P<0.05). CONCLUSION The continuous duplication of hepatitis B virus and HCV concurrent infection,family history with hepatitis B,drinking,low protein diet and psychological factor are risk factors by which the post-hepatic cirrhosis formed.