老年肝硬化病因及临床特点分析

Etiological Analysis and Clinical Characteristics of Liver Cirrhosis in Elderly Patients

目的探讨老年肝硬化的临床特点。方法回顾性分析1998年1月-2010年12月收治的67例老年(年龄≥60岁)肝硬化患者的临床资料,并与72例非老年(年龄<60岁)肝硬化患者进行比较。结果老年组发生黄疸、腹水、白蛋白降低的几率高于非老年组,差异有统计学意义(P<0.05)。老年肝硬化患者的并发症较多,如电解质紊乱、感染、消化道出血、肝性脑病、肝癌、肝肾综合征、肝肺综合征,其发生率均高于非老年肝硬化患者,除肝肾综合征的发生率比较差异无统计学意义(P>0.05)外,其余并发症发生率比较差异均有统计学意义(P<0.05)。引起肝硬化的病因在老年组和非老年组是相同的,最常见病因为乙型肝炎病毒感染,其次为慢性酒精中毒。但非老年组乙型肝炎和非酒精性脂肪性肝炎比老年组多见(P<0.05),老年组慢性酒精中毒、胆汁淤积、药物与毒物中毒和肝脏血液循环障碍比非老年组多见(P<0.05)。老年组肝功能Child-Pugh分级以C级较多,与非老年组C级比较差异有统计学意义(P<0.05);非老年组以A级较多,与老年组A级比较差异有统计学意义(P<0.05)。老年组死亡26例,病死率为38.8%;非老年组死亡13例,病死率为18.1%,两组病死率比较差异有统计学意义(P<0.05)。非老年组的死亡原因主要为消化道出血、电解质紊乱,老年组的死亡原因主要为感染、消化道出血、电解质紊乱和肝性脑病。结论老年肝硬化在病因、临床表现、预后等方面与非老年肝硬化是不同的,积极治疗老年肝硬化的并发症非常重要。

Objective To discuss the clinical characteristics of liver cirrhosis in elderly patients.Methods We retrospectively analyzed the clinical data of 67 patients（elderly group） with liver cirrhosis aged 60 treated between January1998 and December 2010.Then,we compared these cases with another 72 liver cirrhosis patients（non-elderly group） aged 60.Results The incidence of jaundice,ascites and albumin deficiency in the elderly patients was significantly higher than that in the non-elderly patients（P〈 0.05）.Complications in the elderly group were relatively more,including electrolyte imbalance,infections,gastrointestinal bleeding,hepatic encephalopathy,liver cancer,liver and kidney syndrome and liver and lung syndrome,and the incidence of these complications was all significantly higher than the non-elderly group（P〈 0.05） except the liver and kidney syndrome（P〉 0.05）.The causes of liver cirrhosis in both groups were similar.The most common cause was hepatitis B virus infection,followed by chronic alcoholism,but in the elderly group,chronic alcoholism,cholestasis,poisoning from medicines and poisons and liver blood circulation disorders were more common than the non-elderly group（P〈 0.05）;hepatitis B and non-alcoholic fatty hepatitis were more common in the non-elderly group than in the elderly group（P〈 0.05）.The elderly group had more Child-Pugh class C cases（P〈 0.05）,while there were more class A cases in the nonelderly group（P〈 0.05）.Twenty-six patients died in the elderly group with a mortality rate of 38.8%;while only 13 died in the non-elderly group with a mortality rate of 18.1%.The difference of mortality rate was significant between the two groups（P〈 0.05）.Common causes of death in the elderly group were infection,hepatic encephalopathy,and electrolyte disorders and gastrointestinal bleeding,while the common causes of death in the non-elderly group were gastrointestinal bleeding and electrolyte disorders.Conclusions The etiology,clinical manifestations and prognosis of liver cirrhosis in elderly patients differ from those in younger patients.We must pay more attention on treating complications of liver cirrhosis in elderly patients.