慢性乙型肝炎与重型肝炎的临床分型新探

A new proposal for clinical classification of chronic hepatitis B and severe hepatitis

目的探讨慢性乙型肝炎与重型肝炎临床分型存在的问题,提出新的分型建议。方法对124例慢性乙型肝炎及重型肝炎患者的临床资料进行分析,根据丙氨酸氨基转移酶(ALT)、总胆红素(TBil)和凝血酶原活动度(PTA)3个生化指标进行临床分型。结果 124例慢性乙型肝炎患者中,轻型、中型和重型患者分别占总例数的38.7%,31.5%和29.8%。ALT、TBil和PTA 3个指标在不同类型慢性乙型肝炎患者均存在显著性差异。轻型和中型患者的临床治愈好转率均为100%,而重型肝炎患者为51.4%;在重型肝炎患者中,有肝性脑病患者的病死率或无效率显著高于无肝性脑病患者(χ2=,14.4,P=0.000)。结论根据ALT、TBil和PTA 3个生化指标对慢性乙型肝炎进行临床分型,简单实用,值得推广。

Objective To investigate a new proposal for the clinical classification of chronic hepatitis B （CHB） and severe hepatitis. Methods Clinical data of 124 patients with CHB and severe hepatitis were analyzed, restrospectively. Clinical classiifcation were according to the levels of ALT, TBil and PTA. Results There were 48 patients with mild type, 39 patients with medium type and 37 patients with severe type were included among 124 patients with CHB. The percentage of mild, medium and severe type to total was 38.7%, 31.5%and 29.8%, respectively. The levels of ALT, TBil and PTA were signiifcantly different in different types of patients with CHB. The clinical cure rates of mild and medium type were both of 100%and 51.4%of patients with severe type. The mortality rate in patients with hepatic encephalopathy were significantly higher than that of in patients with no hepatic encephalopathy in severe type hepatitis （χ^2=,14.4,P=0.000）. Conclusion It was simple and practical based on ALT, TBil and PTA for clinical classiifcation of CHB, which be worthy of promotion.