急性戊型肝炎严重黄疸患者的临床特征及危险因素分析
DOI: 10.3969/j.issn.1001-5256.2021.03.013
Clinical features and risk factors of acute hepatitis E with severe jaundice
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摘要:
目的 分析伴或不伴严重黄疸的急性戊型肝炎患者的临床特征,并探究发生严重黄疸的危险因素。 方法 回顾性分析2018年1月1日—2020年3月26日上海市公共卫生临床中心收治的179例急性戊型肝炎患者的临床资料。根据TBil是否>171 μmol/L分为AHE伴轻度黄疸(AHE-M)组和AHE伴严重黄疸(AHE-S)组,比较两组临床资料及实验室检查指标。两组间比较采用t检验、Mann-Whitney U检验或χ2检验,独立危险因素分析采用二元logistic回归。 结果 179例患者56.42%(101例)伴严重黄疸。与AHE-M组比较,AHE-S组男性占比多(80.20% vs 61.54%, χ2=7.612, P=0.006),住院时间长[29(19~45)d vs 18(14~22)d, Z=-6.035, P<0.001],发生肝衰竭的人数多[23 vs 0, χ2=18.373, P<0.001],预后差(P<0.001)。AHE-S组基线的抗-HEV-IgM、AFP、肝脏弹性值均高于AHE-M组(Z值分别为-3.534、-3.588、-4.496,P值均<0.001),基线的CD4低于AHE-M组(Z=-2.015,P<0.05),TBil、DBil、肌酐、凝血酶原时间、INR、中性粒细胞绝对数的峰值均高于AHE-M组(Z值分别为-11.016、-10.926、-2.726、-4.787、-4.989、-6.016,P值均<0.01),GGT的峰值、白蛋白、前白蛋白、淋巴细胞绝对数的谷值均低于AHE-M组(Z值分别为-4.550、-4.685、-5.087、-4.818,P值均<0.001)。logistic回归分析显示抗-HEV-IgM(OR=1.022,95%CI: 1.005~1.039,P=0.012)、GGT(OR=0.995,95%CI: 0.993~0.998,P=0.001)、前白蛋白(OR=0.991,95%CI: 0.983~0.999,P=0.02)、中性粒细胞(OR=1.486,95%CI: 1.169~1.889,P=0.001)是急性戊型肝炎患者出现严重黄疸的独立危险因素。 结论 急性戊型肝炎严重黄疸患者男性占比多,住院时间长,发生肝衰竭人数多,预后差,抗-HEV-IgM、GGT、前白蛋白、中性粒细胞是急性戊型肝炎患者出现严重黄疸的独立危险因素。 Abstract:Objective To investigate the clinical features of acute hepatitis E (AHE) patients with or without severe jaundice and the risk factors for severe jaundice. Methods A retrospective analysis was performed for the clinical data of 179 AHE patients who were admitted to Shanghai Public Health Clinical Center Affiliated to Fudan University from January 1, 2018 to March 26, 2020. According to whether total bilirubin (TBil) was > 171 μmol/L, the patients were divided into AHE-mild jaundice (AHE-M) group and AHE-severe jaundice (AHE-S) group, and the two groups were compared in terms of clinical data and laboratory markers. The t test or the Mann-Whitney U test or the chi-squared test was used for comparison, and a binary logistic regression analysis was used to identify independent risk factors. Results Of all 179 patients, 101 (56.42%) were found to have severe jaundice. Compared with the AHE-M group, the AHE-S group had a significantly higher proportion of male patients (80.20% vs 61.54%, χ2=7.612, P=0.006), a significantly longer length of hospital stay [29 (19-45) days vs 18 (14-22) days, Z=-6.035, P < 0.001], a significantly higher number of patients with liver failure (23 vs 0, χ2=18.373, P < 0.001), and a significantly poorer prognosis (P < 0.001). Compared with the AHE-M group, the AHE-S group had significantly higher baseline anti-HEV-IgM, alpha-fetoprotein, and liver elasticity (Z=-3.534, -3.588, and -4.496, all P < 0.001), significantly lower baseline CD4 (Z=-2.015, P < 0.05), significantly higher peak values of TBil, direct bilirubin, creatinine, prothrombin time, international normalized ratio, and absolute neutrophil count (Z=-11.016, -10.926, -2.726, -4.787, -4.989, and -6.016, all P < 0.01), a significantly lower peak value of gamma-glutamyl transpeptidase (GGT) (Z=-4.55, P < 0.001), and significantly lower valley values of albumin, prealbumin (PA), and absolute lymphocyte count (Z=-4.685, -5.087, and -4.818, all P < 0.001). The logistic regression analysis showed that anti-HEV-IgM (odds ratio [OR]=1.022, 95% confidence interval [CI]: 1.005-1.039, P=0.012), GGT (OR=0.995, 95%CI: 0.993-0.998, P=0.001), PA (OR=0.991, 95%CI: 0.983-0.999, P=0.02), and neutrophils (OR=1.486, 95%CI: 1.169-1.889, P=0.001) were independent risk factors for severe jaundice in AHE patients. Conclusion There is a relatively high proportion of male patients among the AHE patients with severe jaundice, with a long length of hospital stay, a large number of patients with liver failure, and poor prognosis. Anti-HEV-IgM, GGT, PA, and neutrophils are independent risk factors for severe jaundice in AHE patients. -
Key words:
- Hepatitis E /
- Jaundice /
- Risk factors
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表 1 两组临床资料比较
指标 AHE-M(n=78) AHE-S(n=101) 统计值 P值 男性[例(%)] 48(61.54) 81(80.20) χ2=7.612 0.006 年龄(岁) 57.40±13.98 61.31±15.49 t=-1.745 0.083 BMI(kg/m2) 23.97±1.89 23.53±1.54 t=1.661 0.099 吸烟史[例(%)] 12(15.38) 12(11.88) χ2=0.465 0.495 饮酒史[例(%)] 13(16.67) 22(21.78) χ2=0.732 0.392 合并基础肝病 12(15.38) 25(24.75) χ2=2.355 0.125 甲型肝炎/丙型肝炎(例) 0 1/1 乙型肝炎[例(%)] 7(8.97) 13(12.87) χ2=0.673 0.412 肝硬化[例(%)] 2(2.56) 8(7.41) χ2=2.394 0.122 脂肪肝[例(%)] 3(3.85) 1(0.99) χ2=1.328 0.249 酒精肝[例(%)] 3(3.85) 3(2.97) χ2=0.029 0.864 合并其他基础疾病[例(%)] 糖尿病 10(12.82) 13(12.87) χ2=0.000 0.992 高血压 22(28.21) 30(29.70) χ2=0.048 0.827 发热[例(%)] 29(37.18) 28(27.72) χ2=1.813 0.178 发病到入院时间(d) 7.5(7.0~14.0) 10.0(7.0~14.0) Z=-1.728 0.084 住院时间(d) 18(14~22) 29(19~45) Z=-6.035 <0.001 发生肝衰竭人数[例(%)] 0 23(22.77) χ2=18.373 <0.001 好转/无效/死亡人数(例) 77/0/1 81/8/12 χ2=14.457 <0.001 表 2 两组实验室指标比较
实验室指标 AHE-M(n=78) AHE-S(n=101) 统计值 P值 抗-HEV-IgM基线(S/CO) 20.18(3.38~40.1) 38.19(12.67~52.02) Z=-3.534 <0.001 ALT峰值(U/L) 1421(640~2469) 1151(630~2246) Z=-0.720 0.472 AST峰值(U/L) 919.00(315.65~1622.15) 753.00(410.00~1441.50) Z=-0.550 0.582 ALP峰值(U/L) 162(127~221) 167(130~205) Z=-0.102 0.919 GGT峰值(U/L) 220.00(135.75~352.25) 123.00(85.50~212.50) Z=-4.550 <0.001 LDH峰值(U/L) 253.50(200.00~348.75) 249.00(200.50~339.00) Z=-0.032 0.974 TBil峰值(μmol/L) 91.60(40.20~127.58) 325.00(222.55~490.00) Z=-11.016 <0.001 DBil峰值(μmol/L) 64.80(22.30~96.40) 222.20(157.00~350.55) Z=-10.926 <0.001 白蛋白谷值(g/L) 35.00(32.44~38.10) 31.90(28.65~35.00) Z=-4.685 <0.001 前白蛋白谷值(mg/L) 98.20(71.49~148.25) 58.50(28.16~93.55) Z=-5.087 <0.001 肌酐峰值(μmol/L) 61.56(53.81~70.88) 68.40(57.20~87.74) Z=-2.726 0.006 凝血酶原时间峰值(s) 13.80(13.10~14.73) 14.09(13.80~19.35) Z=-4.787 <0.001 INR峰值 1.05(0.98~1.14) 1.17(1.06~1.64) Z=-4.989 <0.001 中性粒细胞峰值(109/L) 2.98(2.21~3.93) 4.80(3.37~6.89) Z=-6.016 <0.001 淋巴细胞谷值(109/L) 1.52±0.57 1.13±0.51 t=-4.818 <0.001 CD4绝对数基线(cell/μl) 540.19±209.99 473.62±225.99 t=-2.015 0.045 AFP基线(ng/ml) 6.38(3.18~17.91) 21.39(5.29~105.52) Z=-3.588 <0.001 肝脏弹性值基线(KPA) 8.70(6.50~15.33) 13.40(10.55~19.60) Z=-4.496 <0.001 表 3 AHE-S患者的独立危险因素分析
指标 B值 SE P值 OR 95%CI 性别 -0.614 0.441 0.164 0.541 0.228~1.285 抗-HEV-IgM 0.022 0.009 0.012 1.022 1.005~1.039 GGT -0.005 0.001 0.001 0.995 0.993~0.998 前白蛋白 -0.009 0.004 0.020 0.991 0.983~0.999 肌酐 -0.003 0.003 0.348 0.997 0.991~1.003 INR 0.721 0.682 0.290 2.057 0.540~7.829 中性粒细胞绝对数 0.396 0.123 0.001 1.486 1.169~1.889 AFP 0.000 0.001 0.520 0.999 0.999~1.001 CD4 0.000 0.001 0.650 0.999 0.999~1.002 肝脏弹性值 0.026 0.023 0.243 1.027 0.982~1.073 -
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