大理地区肝硬化病因及并发症变化分析

An analysis on the etiologies and complications of liver cirrhosis in Dali area of China

目的探讨大理地区近10年来肝硬化、肝功能失代偿期患者的病因构成、并发症的变化规律。方法回顾性收集近10年来在大理大学第一附属医院确诊为肝硬化、肝功能失代偿期的患者资料,按照时间分为前5年(2012年1月—2016年12月)和后5年(2017年1月—2021年12月),对比分析前5年和后5年肝硬化患者的病因、并发症变化。结果后5年和前5年肝硬化病因构成无统计学差异,前5位病因仍是:酒精,慢性乙型肝炎,血吸虫、重叠病因以及隐源性,主要的病因是酒精、慢性乙型肝炎、血吸虫。其中后5年病因酒精的患者占比显著多于前5年(36.8%vs 31.1%),差异有统计学意义(χ^(2)=7.030,P=0.008),而后5年病因为慢性乙型肝炎和隐源性的患者占比显著少于前5年(分别为24.4%vs 29.0%、5.6%vs 7.7%),差异有统计学意义(χ^(2)=5.457,P=0.019;χ^(2)=3.844,P=0.050),病因为血吸虫和重叠的患者前5年和后5年差异无统计学意义,分别为15.5%vs 14.0%,8.0%vs 9.6%(χ^(2)=0.882,P=0.348;χ^(2)=1.600,P=0.206);最主要的并发症为腹腔积液和感染。其中后5年并发症为腹腔积液、感染和胆石症的患者占比显著多于前5年(85.8%vs 73.0%,47.0%vs 39.3%,24.5%vs 16.6%),差异有统计学意义(χ^(2)=50.824,P<0.001;χ^(2)=11.848,P=0.001;χ^(2)=18.256,P<0.001),而后5年消化道出血的患者占比显著低于前5年(14.3%vs 28.7%),差异有统计学意义(χ^(2)=62.58,P<0.001),原发性肝癌患者占比前后5年对比差异无统计学意义(9.6%vs 10.4%,χ^(2)=0.381,P=0.537)。结论大理地区肝硬化、肝功能失代偿期最主要的病因是酒精,其次为慢性乙型肝炎和血吸虫,酒精所导致的肝硬化呈上升趋势,慢性乙型肝炎所导致的肝硬化呈下降改变;最常见的并发症是腹腔积液和感染,且呈上升趋势。

Objective To investigate the changing regularity of the etiologies and complications of patients with cirrhosis and decompensated liver function in Dali area in recent 10 years.Methods A retrospective study was conducted to collect the data of patients with liver cirrhosis and decompensated liver function in the First Affiliated Hospital of Dali University in the past 10 years,and to compare the causes and complications between the first five years(from January 2012 to December 2016)and the last five years(from January 2017 to December 2021).Results There was no statistical difference between the causes of cirrhosis in the last 5 years and the first 5 years.The top 5 causes were alcohol,chronic hepatitis B,schistosomiasis,overlapping causes and cryptogenic cirrhosis.The main causes were alcohol,chronic hepatitis B and schistosomiasis.The proportion of patients with alcoholic liver cirrhosis in the second 5 years was significantly higher than that in the first 5 years(36.8%vs 31.1%),the difference was statistically significant(χ^(2)=7.030,P=0.008),and the proportion of patients with chronic hepatitis B and cryptogenic cirrhosis in the second 5 years was significantly lower than that in the first 5 years(24.4%vs 29.0%,5.6%vs 7.7%,respectively).The difference was statistically significant(χ^(2)=5.457,P=0.019;χ^(2)=3.844,P=0.050),there was no significant difference between the proportions of patients with schistosomiasis and overlapping causes in the first 5 years and the last 5 years,which were 15.5%vs 14.0%,and 8.0%vs 9.6%(χ^(2)=0.882,P=0.348;χ^(2)=1.600,P=0.206);The most common complications were abdominal effusion and infection.The proportion of patients with complications of abdominal effusion,infection and cholelithiasis in the last 5 years was significantly higher than those in the first 5 years(85.8%vs 73.0%,47.0%vs 39.3%,and 24.5%vs 16.6%),the difference was statistically significant(χ^(2)=50.824,P<0.001;χ^(2)=11.848,P=0.001;andχ^(2)=18.256,P<0.001),the proportion of patients with gastrointestinal bleeding in the last 5 years was significantly lower than that in the first 5 years(14.3%vs 28.7%),the difference was statistically significant(χ^(2)=62.58,P<0.001).There was no significant difference in the proportion of patients with primary liver cancer(9.6%vs 10.4%,χ^(2)=0.381,P=0.537).Conclusion The main cause of liver cirrhosis and liver function decompensation in Dali area is alcohol,followed by chronic hepatitis B and schistosomiasis.The cirrhosis caused by alcohol is on the rise,while the cirrhosis caused by chronic hepatitis B is in the decline.The most common complications were abdominal effusion and infection,which were on the rise.