重型病毒性肝炎预后的临床分析

The Clinical Analysis of Prognosis of Severe Viral Hepatitis

目的:探讨影响重型肝炎(重肝)预后的因素。方法:本文总结了207例重型病毒性肝炎资料。结果:(1)重肝好发年龄主要分布于30～50岁,年龄越大,死亡率越高,老年患者病死率达71.4％;(2)单纯HBV感染是重肝的主要病因,占70.5％,其病死率49.65％,而重叠病毒感染(HBV+HCV和/或HBV+HEV)均明显加重病情,病死率达55.56％和53.65%;(3)重肝早期治疗有效率达65.4%,而中晚期疗效差,有效率34.8％和11.3％;(4)重肝按脑病型、腹水型、混和型及其它型分型,各型治愈好转率有明显差异,分别为25％、42％、7%和63％;(5)并发症多少与转归明显关联,0～1种存活率46%,2～3种13.3％,4～5种5.4%;(6)重肝患者常伴有胆结石胆囊炎(12.6%)、糖尿病(Ⅱ型)(4.8%)、胰腺炎(0.7％)等。结论:年龄大小,病因不同,临床类型不同,并发症多少及伴随疾患的有无,均会影响重肝转归。

Purpose: To find some factors of affecting severe hepatitis(SH) prognosis. Methods: We analyzed clinical data of severe viral hepatitis cases. Results: (1)SH mainly prevalences on 30-50 years of age, the more elder, the higher mortalities, mortalities of old patients are 71.4% ; (2) simple HBV infection is main cause of severe hepatitis(about 70. 5% ) , it' s mortality reached 49. 65% , but superinfection (HBV + HCV and/or HBV + HEV) can make disease markedly heavier, their mortalities are 55. 56% and 53. 65% respectively; (3)effective ratio of early therapeutics to SH is 65.4% , but that of medium and later stage are 34.8% and 11.3% respectively; (4)SH is divided into hepatic encephabpathy, ascites, en-cephalopathy plus ascites and non-encephalopathy plus ascites, the surival rate of every type have markedly difference, respective 25%, 42%, 7% and 63%; (5)complications have markedly related to prognosis, surival rates of 0-1 complications is 46% , 2-3 complication 13. 3% , 4-5 complication 5.4%; (6)patients with SH often accompany cholelithiasis and cholecystitis(12. 6 %), diabetes( Ⅱ type) (4.8%), pan-creatitis(0.7%) etc. Conclusion: age, cause, clinical type, complication and accompany disease can influence survial rate of SH.