近10年肝病住院患者疾病变化趋势分析

Trend analysis of constituent ratios of hospitalization choronosology in patients with liver disease during the last 10 years in China:a single-centre experience

目的探讨感染科肝病组住院患者疾病谱的变化,为肝病管理提供循证依据。方法收集2005年1月至2014年12月感染病科收治的所有住院病患,记录患者的性别、年龄、第一出院诊断、治疗转归等。分析近10年来肝病构成比的变化。结果肝病占住院病例的比例逐年下降,最高为2005年59.65%,最低为2013年35.91%,这种分布从2010年起有统计学意义。慢性乙型肝炎仍然是肝病组最主要的住院原因。历年肝病构成比变化差异无统计学意义。急性肝炎最常见的病因为急性甲型肝炎,急性乙型肝炎,急性戊型肝炎,胆源性肝损伤,药物性肝损伤。胆源性肝损伤和药物性肝损伤占急性肝炎的比例有上升趋势:2005年胆源性肝损伤占急性肝病的比例为8.70%,2010年为32.43%,2014年为33.92%;药物性肝损伤占急性肝病比率这3年分别是:13.77%、21.062%和40.35%。慢性乙型肝炎占慢性肝炎的比例历年分布差异无统计学意义。肝病患者的好转率和病死率历年无显著性差异。结论慢性乙型肝炎的构成比有减少趋势,非传染性肝病的构成有上升趋势。从管理层面,肝病的防治涉及到多学科的交叉合作。

Objective To explore the changes of hospitalization choronosology in liver disease from 2005 to 2014, and to provide an evidence-based basis for liver disease management. Methods The medical records of all inpatients in infectious diseases department from January 2005 to December 2014, including gender, age, principal discharge diagnosis and treatment outcome, were collected to analyze changes of disease spectrum on liver in recent 10 years. Results The proportion of liver disease accounted for hospitalizations decreased annually, from highest （59. 65%） in 2005 to lowest （35.91%） in 2013, which showed statistically significant difference since 2010. Chronic hepatitis B was still the main cause leading to liver disease for hospitalization. Changes of liver disease spectrum had no marked differences among years. The main causes of acute hepatitis were acute hepatitis A, B, E, biliogenic and drug-induced liver damage. Furthermore, proportion of biliogenic liver damage （8.70% in 2005, 32.43% in 2010 and 33. 92% in 2014） and drug-induced liver damage （13.77% in 2005, 21. 062% in 2010 and 40.35% in 2014） in acute hepatitis had a rising trend. Among these years, there was no statistical difference in proportions of chronic hepatitis B accounted for the chronic hepatitis. Also no obvious changes were found in recovery rate and mortality rate of liver disease patients. Conclusion The constituent ratio of chronic hepatitis B accounting for chronic hepatitis showed a downward trend, while that of non-communicable liver disease displayed an upward trend. Considered in disease management, prevention and control of liver disease might need multidisciplinary cooperation.