74例慢性乙型肝炎患者急性发作临床特征分析

Clinical features of patients with acute exacerbation of chronic hepatitis B: an analysis of 74 cases

目的探讨慢性乙型肝炎急性发作临床特点,为诊断、治疗慢性乙型肝炎急性发作提供循证医学证据。方法回顾性分析海口市人民医院2011年1月-2015年10月确诊的74例慢性乙型肝炎急性发作患者的临床资料。将纳入患者分为HBe Ag阳性组（n=51）和阴性组（n=23）。计量资料两组间比较采用t检验,计数资料组间比较采用χ2检验。结果慢性乙型肝炎急性起病,ALT水平为523-2940 U/L,表现为黄疸型肝炎64例（86.49%）,4周内临床治愈65例（87.84%）。HBe Ag阳性组与HBe Ag阴性组基线ALT、AST、HBV DNA水平差异均无统计学意义（P值均〉0.05）,但HBe Ag阴性组患者的TBil水平[（141.1±132.9）μmol/L]较阳性组[（80.1±68.8）μmol/L]高,差异有统计学意义（t=2.745,P=0.007）。结论慢性乙型肝炎急性发作发病过程类似于急性乙型肝炎,HBe Ag阴性患者的TBil水平较高,肝细胞损伤较重。

Objective To investigate the clinical features of patients with acute exacerbation of chronic hepatitis B,and to provide a basis of evidence- based medicine for the diagnosis and treatment of acute exacerbation of chronic hepatitis B. Methods A retrospective analysis was performed for the clinical data of 74 patients with acute exacerbation of chronic hepatitis B who were diagnosed in The People＇s Hospital of Haikou from January 2011 to October 2015. These patients were divided into HBe Ag positive group（ 51 patients） and HBe Ag negative group（ 23 patients）. The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. Results The patients with acute onset of chronic hepatitis B had a level of alanine aminotransferase（ ALT） of 523- 2940 U/L and were manifested as icteric hepatitis（ 64 patients,86. 49%）,and 65 patients（ 87. 84%） were cured within4 weeks. There were no significant differences in baseline ALT,aspartate aminotransferase,and HBV DNA levels between the HBe Ag positive group and the HBe Ag negative group（ all P〉0. 05）,and the HBe Ag negative group had a significantly higher level of total bilirubin（ TBil） than the HBe Ag positive group（ 141. 1 ± 132. 9 μmol/L vs 80. 1 ± 68. 8μmol/L,t = 2. 745,P = 0. 007）. Conclusion The acute exacerbation of chronic hepatitis B is similar to acute hepatitis B,and the patients with negative HBe Ag have a high level of TBil and severe hepatocyte injury.