兰州地区肝硬化的病因构成及临床特征分析

沈自雄; 李敏; 张嵴明; 李金洲; 苟海燕; 王艺璇

doi:10.3969/j.issn.1001-5256.2020.04.015

兰州地区肝硬化的病因构成及临床特征分析

DOI: 10.3969/j.issn.1001-5256.2020.04.015

1. 兰州大学第一临床医学院
2. 兰州大学第一医院感染科
3. 兰州大学第二临床医学院

基金项目:

甘肃省卫生行业科研计划项目(GSWSKY2017-45)； 2017年兰州大学第一医院院内基金项目(ldyyyn2017-10)；兰州大学2018年大学生创新创业项目行动计划(20180060122)；

详细信息

中图分类号: R575.2
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出版历程
- 收稿日期: 2019-12-06
- 出版日期: 2020-04-20

Etiologies and clinical features of liver cirrhosis in Lanzhou,China

The First Clinical Medical College of Lanzhou University

Research funding:

摘要

摘要: 目的探讨兰州地区肝硬化患者病因构成及临床特征,分析肝硬化并发原发性肝癌的危险因素。方法回顾性分析2015年4月-2018年4月兰州大学第一医院感染科诊治的3496例肝硬化患者病历资料,包括性别、年龄、家族史、既往史、个人史,以及病因、临床表现、并发症、实验室检查结果等。计数资料组间比较采用χ2检验,肝硬化并发肝癌的危险因素分析采用多元logistic回归分析。结果 3496例肝硬化患者中乙型肝炎2209例（63. 19%）[2209例患者中有2032例HBeAg信息完整,2032例患者中HBeAg阳性807例（39. 71%）,HBeAg阴性1225例（60. 29%）; 2209例患者中有2207例有HBV DNA信息,HBV DNA阳性1567例（71. 00%）]。丙型肝炎309例（8. 84%）,自身免疫性肝炎144例（4. 12%）,原发性胆汁性胆管炎133例（3. 80%）,酒精性93例（2. 66%）,隐源性肝硬化447例（12. 79%）。主要临床表现为脾大和（或）血细胞减少症2299例（65. 76%）、腹水1760例（50. 34%）、食管静脉...
- 肝硬化 /
- 肝肿瘤 /
- 疾病特征 /
- 危险因素
Abstract: Objective To investigate the etiologies and clinical features of patients with liver cirrhosis in Lanzhou,China and the risk factors for liver cirrhosis with primary liver cancer. Methods A retrospective analysis was performed for the medical records of 3496 patients with liver cirrhosis who were diagnosed and treated in Department of Infectious Diseases,The First Hospital of Lanzhou University,from April 2015 to April 2018,including sex,age,family history,past history,personal history,etiology,clinical manifestation,complication,and laboratory examination. The chi-square test was used for comparison of categorical data between groups,and the multivariate logistic regression analysis was used to investigate the risk factors for liver cirrhosis with liver cancer. Results Among the 3496 patients with liver cirrhosis,2209( 63. 19%) had hepatitis B,among whom 2032 patients had complete HBe Ag data,with 807( 39. 71%) HBe Ag-positive patients and 1225( 60. 29%) HBe Ag-negative patients; among these 2209 patients,2207 had HBV DNA data,among whom 1567( 71. 00%) had positive HBV DNA. There were 309 patients( 8. 84%) with hepatitis C,144 patients( 4. 12%) with autoimmune hepatitis,133 patients( 3. 80%)with primary biliary cholangitis,93 patients( 2. 66%) with alcoholic cirrhosis,and 447 patients( 12. 79%) with cryptogenic cirrhosis. Major clinical manifestations included splenomegaly and/or hemocytopenia in 2299 patients( 65. 76%),ascites in 1760 patients( 50. 34%),esophageal varices in 1647 patients( 47. 11%),gastric varices in 1386 patients( 39. 66%),and jaundice in 754 patients( 21. 57%). The main complications included primary liver cancer in 937 patients( 26. 80%),gastrointestinal bleeding in 822 cases( 23. 51%),infection in 697 patients( 19. 94%) [mainly pulmonary infection in 487 patients( 13. 93%) ],and hepatic encephalopathy in 261 patients( 7. 47%). The patients with hepatitis B cirrhosis had a significantly higher incidence rate of primary liver cancer than those with alcoholic hepatitis cirrhosis( χ2= 26. 854,P < 0. 001); the patients with alcoholic cirrhosis had a significantly higher incidence rate of gastrointestinal bleeding than those with hepatitis B cirrhosis( χ2= 5. 031,P = 0. 025); the patients with hepatitis B cirrhosis had a significantly lower incidence rate of hepatic encephalopathy than those with alcoholic cirrhosis( χ2= 40. 903,P < 0. 001). Among the patients with a confirmed diagnosis of primary liver cancer,73. 22% had positive alpha-fetoprotein( AFP) and 26. 78% had negative AFP. Age( odds ratio [OR]= 1. 025,95% confidence interval[CI]: 1. 017-1. 034,P <0. 05),male sex( OR =2. 701,95% CI: 2. 168-3. 365,P <0. 05),positive HBV DNA( OR =1. 361,95% CI:1. 123-1. 649,P < 0. 05),hypertension( OR = 2. 372,95% CI: 1. 845-3. 050,P < 0. 05),and a family history of liver cancer( OR =2. 261,95% CI: 1. 255-4. 075,P < 0. 05) were risk factors for primary liver cancer in patients with liver cirrhosis. Conclusion Hepatitis B is the main etiology of liver cirrhosis in Lanzhou,followed by hepatitis C and autoimmune liver disease. The main clinical manifestations are splenomegaly and/or hemocytopenia,and the main complication is primary liver cancer. Active antiviral therapy and prevention of hypertension may help to reduce the risk of primary liver cancer in patients with liver cirrhosis.
- liver cirrhosis /
- liver neoplasms /
- disease attributes /
- risk factors

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