摘要
目的 本研究旨在探讨北京大学第一医院(甲中心)和贵州省人民医院感染病科(乙中心)近年来肝硬化住院患者的病因和并发症构成比的差异.方法 2018 年 1 月～2020 年 12 月甲中心收治的肝硬化患者 1813 例,乙中心388 例.剔除病例后,纳入甲中心700 例和乙中心340 例,甲中心乙型肝炎肝硬化患者 252 例,乙中心为 137 例.结果 两中心肝硬化病因仍以乙型肝炎、丙型肝炎、酒精性肝病(ALD)、原发性胆汁性肝硬化和自身免疫性肝炎为主,药物性肝损伤、遗传代谢性肝病和隐源性较少,乙中心患者ALD占比为23.2％,乙型肝炎合并ALD占比为 17.7％,显著高于甲中心(分别为13.0％和4.1％,P<0.05);甲中心肝细胞癌发生率为27.0％,显著高于乙中心的 14.1％(P<0.05),而乙中心患者食管胃底静脉曲张、腹水、感染和肝功能Child C级发生率分别为61.5％、80.6％、50.9％和52.1％,显著高于甲中心的43.4％、39.3％、17.4％和14.1％(P<0.05).结论 我国肝硬化的病因仍为HBV感染为主,但不同地区可能存在些许差异,有些地区患者肝功能状态可能更差,严重并发症更多,需及时予以处理.
Abstract
Objective This study aimed to investigate the etiologies and complications in adults with liver cirrhosis(LC)in First Hospital,Peking University(Center A)and Guizhou Provincial People's Hospital(Center B).Methods A total of 1813 patients with LC in Center A,388 LC patients in Center B were hospitalized between January 2018 and December 2020,and after exclusion,700 patients(including hepatitis B in 252 cases)in the former and 340 patients(HBV infection in 137 cases)in the latter were enrolled in this study.Results The common causes of LC in the two centers were hepatitis B,hepatitis C,alcoholic liver diseases(ALD),primary biliary cirrhosis and autoimmune hepatitis,with some uncommon etiologies,such as drug-induced liver injury,inherited metabolic liver disease and cryptogenic liver diseases;the ALD accounted for 23.2%and hepatitis B with concomitant ALD for 17.7%in Center B,both significantly higher than 13.0%and 4.1%(P<0.05)in Center A;incidence of hepatocellular carcinoma in Center A was 27.0%,much higher than 14.1%(P<0.05)in Center B,while the percentages of patients with esophagogastric varices,ascites,infections and Child-Pugh class C in Center B were 61.5%,80.6%,50.9%and 52.1%,all much higher than 43.4%,39.3%,17.4%and 14.1%(P<0.05)in Center A.Conclusion The main causes of LC in China are still HBV infection and ALD,which varied a little in different regions,and patients in some areas might have a poor liver function states,more complications and need more attentions.
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