急性和亚急性重型肝炎47例死亡病例的临床分析

Clinical analysis of 47 cases died from acute and subacute severe hepatitis

目的 分析 2 6例急性重型肝炎 (ASH)和 2 1例亚急性重型肝炎 (SSH)的病理和临床特点。方法 对我院近 2 0年经尸检或肝穿刺病理证实死亡的ASH和SSH患者的临床特点进行分析。结果 ①ASH和SSH昏迷发生的时间 ,发病 10d内昏迷者ASH为 80 .1% ,发病 14d内昏迷者ASH为 92 .0 % ;②发病年龄分别为 (35± 11)岁和 (5 3± 11)岁 ,P <0 .0 0 1;③脑水肿的发生率分别为 10 0 %和 6 1.9% ,P <0 .0 1;④较大量腹水的发生率分别为35 .3%和 10 0 .0 % ;⑤胆固醇均降低 ,且降低的数值及PTA变化与疾病发生、发展密切相关 ;⑥ 2例急性黄疸型肝炎患者在疾病恢复期转型为急性重型肝炎。结论 ①急性重型肝炎约有 1/ 3患者可出现较大量腹水 ;②PTA、CHO与疾病变化密切相关 ;③急性肝炎治疗期间可以因为某些特殊诱因而出现转型 ,转型后的临床和病理与急性重型肝炎相同 。

Objective To analyze the pathological and clinical features of 26 ASH and 21 SSH cases for helping the clinical diagnosis and treatment of severe hepatitis.Methods The clinical features of the ASH and SSH death cases,proved by autopsy and liver biopsy in our hospital during the past 20 years,are analyzed using EXCEL 2000.Results ①80.1% of ASH patients had coma within 10 days and 92.0% had coma within 14 days after the appearance of the disease;② The age of ASH and SSH is 35±11 and 53±11 respectively, P <0.001;③ The incident of cerebral edema 100% and 61.9% respectively, P <0.01;④ The incident of a large amount of ascites is 35.3% and 100.0% respectively;⑤Cholesterol decreases in both ASH and SSH cases, and the degree of decrease and the change of PTA are closely related to the severity of the diseases;⑥2 cases of acute icterohepatitis changed into acute severe hepatitis during the convalescence.Conclusions ①Taking 2 weeks as cutoff between the ASH and SSH is clinically appropriate;②Approximately 1/3 of the acute severe hepatitis have a large amount of ascites;③PTA and CHO are closely related to the severity of the diseases;④The acute hepatitis can change into severe hepatitis due to some factors and should be managed as the ASH.