本文選題：肝臟疾病　切入點(diǎn)：疾病譜　出處：《南京醫(yī)科大學(xué)》2017年博士論文

【摘要】：第一部分肝臟疾病住院患者疾病譜變化趨勢(shì)目的:分析住院肝病患者的疾病譜變化,了解本醫(yī)療機(jī)構(gòu)收治的病毒性肝炎患者趨勢(shì)是否發(fā)生變化。方法:以2006年1月至2014年12月期間入住南京醫(yī)科大學(xué)第一附屬醫(yī)院感染病科的患者為研究對(duì)象,回顧性分析肝病患者的病因變化、病毒性肝炎中不同肝炎病毒感染比例、不同年齡段乙型肝炎比例變化趨勢(shì)等。結(jié)果:1、連續(xù)9年期間,住院患者中肝病的比例逐漸下降,最高為2006年達(dá)64.46%,最低為2013年降至39.89%,但患者數(shù)量有所增加,2006年為497人,而2014年達(dá)798人。前五位的肝病病因依次是病毒性肝炎、藥物性肝病、自身免疫性肝病、酒精性肝病和非酒精性脂肪性肝病,總比例分別為62.61%、10.70%、4.96%、3.18%和1.90%,其中病毒性肝炎比例逐漸下降,而藥物性肝病和自身免疫性肝病比例明顯上升。2、病毒性肝炎患者中,乙型肝炎、丙型肝炎和戊型肝炎比例處于前三位,其中乙型肝炎穩(wěn)定在70%左右,而丙型肝炎比例呈現(xiàn)上升趨勢(shì),由2006年8.45%上升至2014年的15.58%;乙型肝炎患者每年平均住院時(shí)間呈逐漸縮短趨勢(shì),差異具有明顯的統(tǒng)計(jì)學(xué)意義(P0.001);乙型肝炎患者主要分布在31-60歲年齡段,合計(jì)比例在60%以上,同一年齡組各年份比例間差異無(wú)統(tǒng)計(jì)學(xué)意義,而14-23歲年齡段,乙型肝炎患者比例逐漸降低,差異有統(tǒng)計(jì)學(xué)意義(P=0.01)。結(jié)論:1、肝病在本機(jī)構(gòu)感染病科的病種分布中依然占有重要地位;藥物性肝病和自身免疫性肝病等非感染性的肝病應(yīng)引起足夠的重視和關(guān)注。2、本機(jī)構(gòu)感染病科收治的病毒性肝炎住院患者中,乙型肝炎和丙型肝炎依然嚴(yán)重;乙型肝炎和丙型肝炎患者的發(fā)病趨勢(shì)為其防治提出新的挑戰(zhàn)。第二部分HBV或HCV感染與肝外腫瘤相關(guān)性研究目的:肝炎病毒與肝細(xì)胞肝癌具有相關(guān)性眾所周知,國(guó)際上雖然已有研究顯示與肝外腫瘤關(guān)聯(lián),但本地區(qū)的狀況并不清楚。方法:1、2008年1月至2016年12月期間入住南京醫(yī)科大學(xué)第一附屬醫(yī)院的患者,選取診斷為淋巴瘤、乳腺癌、甲狀腺癌、腎癌和胰腺癌以及同期診斷為非腫瘤疾病的住院患者為研究對(duì)象。2、采用回顧性方法進(jìn)行病例對(duì)照研究,以上五種肝外腫瘤患者設(shè)為研究組,同期住院非腫瘤疾病的患者為對(duì)照組,研究組和對(duì)照組依據(jù)性別、年齡等資料進(jìn)行1:1完全匹配。3、以乙型肝炎表面抗原檢測(cè)陽(yáng)性為HBV感染標(biāo)志物,丙型肝炎抗體檢測(cè)陽(yáng)性為HCV感染標(biāo)志物。分析研究組和對(duì)照組之間乙型肝炎表面抗原、乙型肝炎表面抗體、乙型肝炎核心抗體、丙型肝炎抗體等陽(yáng)性率的差異性,并計(jì)算比值比及其95%可信區(qū)間。同時(shí),研究組檢測(cè)數(shù)據(jù)資料與2006年全國(guó)HBV、HCV血清流行病學(xué)調(diào)查結(jié)果進(jìn)行乙型肝炎表面抗原陽(yáng)性率的比較分析。4、選取彌漫大B細(xì)胞淋巴瘤患者,研究HBV感染與HBV非感染者之間性別和發(fā)病年齡的分布差異性。結(jié)果:1、分析五種肝外腫瘤患者與醫(yī)院非腫瘤住院患者對(duì)照人群HBV感染率的差異性,結(jié)果顯示淋巴瘤中非霍奇金淋巴瘤(OR = 2.10;95%CI,1.72-2.56),非霍奇金淋巴瘤中的B細(xì)胞淋巴瘤(OR= 2.33;95%(CI,1.90-2.86),以及其亞型中的彌漫大B細(xì)胞淋巴瘤(OR = 2.07;95%CI,1.62-2.64)、濾泡性淋巴瘤(OR = 3.38;95%CI,2.28-5.00)、邊緣區(qū)淋巴瘤(OR = 2.23;95%CI,1.37-3.62)、慢性淋巴細(xì)胞白血病/小淋巴細(xì)胞(OR=1.91;95%CI,1.03-3.55)、黏膜相關(guān)淋巴組織淋巴瘤(OR=1.85;95%CI,1.00-3.44)、脾邊緣區(qū)淋巴瘤(OR = 5.86;95%CI,2.28-15.28)等HBV感染率均明顯高于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義。除胰腺癌(OR=1.40;95%CI,1.07-1.84)外,乳腺癌、甲狀腺癌、腎癌HBV感染率與對(duì)照組相比,差異未見(jiàn)明顯統(tǒng)計(jì)學(xué)意義(P值分別為0.873、0.308、0.331);但乳腺癌、甲狀腺癌、腎癌以及胰腺癌抗-HBc陽(yáng)性率均明顯高于對(duì)照組,差異有明顯統(tǒng)計(jì)學(xué)意義(P值分別為0.003、0.001、0.003)。2、以全國(guó)2006年HBV血清流行病學(xué)調(diào)查結(jié)果為對(duì)照,對(duì)HBV感染率差異性進(jìn)行了進(jìn)一步研究,B細(xì)胞非霍奇金淋巴瘤亞型的分析發(fā)現(xiàn),男性群體中除邊緣區(qū)淋巴瘤以及黏膜相關(guān)淋巴組織淋巴瘤HBV感染率與對(duì)照差異未見(jiàn)明顯統(tǒng)計(jì)學(xué)意義外(P值分別為0.548、0.603),其余HBV感染率均明顯高于對(duì)照。而對(duì)于女性群體,B細(xì)胞非霍奇金淋巴瘤亞型HBV感染率均明顯高于對(duì)照,差異有統(tǒng)計(jì)學(xué)意義。對(duì)于乳腺癌、甲狀腺癌、腎癌以及胰腺癌的研究,無(wú)論男性還是女性患者,并未發(fā)現(xiàn)HBV感染率與對(duì)照的差異有明顯統(tǒng)計(jì)學(xué)意義。3、以彌漫大B細(xì)胞淋巴瘤亞型患者為研究對(duì)象,分析比較了彌漫大B細(xì)胞淋巴瘤中HBV感染者與非HBV感染者性別、發(fā)病年齡分布的差異性,結(jié)果均未發(fā)現(xiàn)二者差異有明顯統(tǒng)計(jì)學(xué)意義(P值分別為0.941、0.232)。4、本研究入組的淋巴瘤、乳腺癌、甲狀腺癌、腎癌和胰腺癌,其抗-HCV陽(yáng)性率分別為0.75%、0.50%、0.33%、0.39%、0.75%,與各自住院患者對(duì)照組抗-HCV陽(yáng)性率相比較,差異未見(jiàn)明顯統(tǒng)計(jì)學(xué)意義;并且淋巴瘤的各亞型抗-HCV陽(yáng)性率與住院患者對(duì)照組相比較,也未發(fā)現(xiàn)差異有明顯統(tǒng)計(jì)學(xué)意義。在與全國(guó)2006年HCV血清流行病學(xué)調(diào)查結(jié)果比較時(shí),男性群體中五種肝外腫瘤抗-HCV陽(yáng)性率與全國(guó)數(shù)據(jù)比較,差異均未見(jiàn)明顯統(tǒng)計(jì)學(xué)意義。在女性群體中,乳腺癌、甲狀腺癌、腎癌和胰腺癌抗-HCV陽(yáng)性率與全國(guó)數(shù)據(jù)比較,差異也未見(jiàn)明顯統(tǒng)計(jì)學(xué)意義,而淋巴瘤亞型中的慢性淋巴細(xì)胞白血病/小淋巴細(xì)胞抗-HCV陽(yáng)性率為5.56%,與全國(guó)數(shù)據(jù)比較差異均有明顯統(tǒng)計(jì)學(xué)意義(P=0.001)。結(jié)論:1、非霍奇金淋巴瘤及其部分亞型、胰腺癌等的發(fā)生與HBV感染存在一定的相關(guān)性。2、彌漫大B細(xì)胞淋巴瘤患者中HBV感染與HBV非感染者,性別和發(fā)病年齡分布未見(jiàn)明顯差異。3、女性患者慢性淋巴細(xì)胞白血病/小淋巴細(xì)胞淋巴瘤與HCV感染存在一定的相關(guān)性。
[Abstract]:Changing trends of inpatient disease spectrum to the first part: the analysis of liver disease spectrum changes of hospitalized patients with liver disease, to understand the trend of viral hepatitis patients admitted to medical institutions are changed. Methods: the First Affiliated Hospital of Nanjing Medical University Department of infection during the period from January 2006 to December 2014 were selected as the research object, a retrospective analysis of etiology changes in patients with liver disease different, hepatitis B virus infection of viral hepatitis in the proportion of different age of hepatitis B ratio trend. Results: 1, for 9 consecutive years, the proportion of hospitalized patients with liver disease decreased gradually, the highest reached 64.46% in 2006, the lowest for 2013 to 39.89%, but the number of patients increased 497 in 2006 and 2014. Up to 798 people. The etiology of liver disease before five were viral hepatitis, drug-induced liver disease, autoimmune liver disease, alcoholic liver disease and alcohol Fatty liver disease, the proportion of the total were 62.61%, 10.70%, 4.96%, 3.18% and 1.90%, the proportion of viral hepatitis decreased, and drug-induced liver disease and autoimmune liver disease significantly increased the proportion of.2 in patients with viral hepatitis, hepatitis B, hepatitis C and hepatitis E, the proportion of the top three, including B B stable at around 70%, and the proportion of hepatitis C showed a rising trend, up from 8.45% in 2006 to 15.58% in 2014; the annual average hospitalization time of patients with hepatitis B decreased, the difference is significant (P0.001); hepatitis B patients mainly distributed in 31-60 years of age, the proportion of the total is more than 60%, no significant the significance of each year the same age group the proportion difference, and 14-23 years of age, the proportion of patients with hepatitis B gradually decreased, the difference was statistically significant (P=0.01). Conclusion: 1. The mechanism of infectious diseases in liver disease Still occupies an important position in the distribution of diseases in the Department of medicine; liver disease and autoimmune liver diseases and non infectious disease should arouse enough attention and concern of.2, the mechanism of viral hepatitis infection diseases were hospitalized patients, hepatitis B and hepatitis C are still serious; hepatitis B and hepatitis C in patients with the incidence trend of it new challenges for its prevention and treatment. The second part studies the relationship between HBV or HCV infection and hepatic tumor Objective: hepatitis B virus and hepatocellular carcinoma associated with the world as everyone knows, although research has shown that tumor associated with liver, but the region's status is not clear. Methods: the patients in the First Affiliated Hospital of Nanjing Medical University during the period from January 12008 to December 2016 in selection, diagnosis of lymphoma, breast cancer, thyroid cancer, renal cell carcinoma and pancreatic cancer and the corresponding diagnosis for non tumor disease in hospital patients The research object of.2, using the method of retrospective case-control study, more than five patients with extrahepatic tumor for the study group, hospitalized non neoplastic disease patients as the control group, the study group and the control group according to gender, age,.3 1:1 complete data for the detection of hepatitis B surface antigen as a marker HBV infection, detection of hepatitis C virus antibody positive for markers of HCV infection. The analysis between the study group and the control group of hepatitis B surface antigen, hepatitis B surface antibody, hepatitis B core antibody, the difference of the positive rate of antibody to hepatitis C, and calculate the odds ratios and 95% confidence intervals. At the same time, the research group of testing data and 2006 the results of HBV, HCV positive rate of serum epidemiological survey of hepatitis B surface antigen.4 comparative analysis, selected patients with diffuse large B cell lymphoma, the infection of HBV and non HBV infection The distribution of the difference between gender and age. Results: 1, analysis of hospitalized patients with cancer were HBV infection rate of five patients with extrahepatic tumor hospital, showed non Hodgkin lymphoma lymphoma (OR = 2.10; 95%CI, 1.72-2.56), B cell lymphoma in non Hodgkin lymphoma (OR= 2.33 95%; (CI, 1.90-2.86), and its subtypes of diffuse large B cell lymphoma (OR = 2.07; 95%CI, 1.62-2.64), follicular lymphoma (OR = 3.38; 95%CI, 2.28-5.00), marginal zone lymphoma (OR = 2.23; 95%CI, 1.37-3.62), chronic lymphocytic leukemia / small lymphocytes (OR=1.91; 95%CI, 1.03-3.55), mucosa associated lymphoid tissue lymphoma (OR=1.85; 95%CI, 1.00-3.44), splenic marginal zone lymphoma (OR = 5.86; 95%CI, 2.28-15.28) HBV infection rate was significantly higher than that of control group, the difference was statistically significant. In addition to pancreatic cancer (OR=1.40; 95%CI, 1.07-1.84) and, Breast cancer, thyroid cancer, renal cell carcinoma HBV infection rate compared with the control group, the difference was significant (P = 0.873,0.308,0.331); breast cancer, thyroid cancer, renal cell carcinoma, pancreatic cancer, anti -HBc positive rate were significantly higher than the control group, the difference was statistically significant (P =.2, 0.003,0.001,0.003) in 2006 the national epidemiological survey of serum HBV as control, the infection rate of HBV difference was further studied, analysis of B cell non Hodgkin's lymphoma subtypes found in male group removal rate compared with no obvious statistical significance of marginal zone lymphoma of mucosa associated lymphoid tissue lymphoma and HBV infection (P = 0.548,0.603 the infection rate of HBV), were significantly higher than that of control. But for women, B cell non Hodgkin's lymphoma subtype HBV infection rate were significantly higher than that in control, the difference was significant Meaning. For breast cancer, thyroid cancer, renal cancer and pancreatic cancer, both men and women, did not find the HBV infection rate between the control and the statistically significant.3, diffuse large B cell lymphoma subtype patients as the research object, analysis and comparison of HBV infection in diffuse large B cell lymphoma and non HBV infection sex, age distribution sex differences, the results indicated that there were no statistically significant difference between the two groups (P = 0.941,0.232).4, the research group of lymphoma, breast cancer, thyroid cancer, renal cell carcinoma and pancreatic cancer, the anti -HCV positive rates were 0.75%, 0.50%, 0.33%, 0.39% 0.75%, with the respective control group, patients with anti -HCV positive rate comparison, no significant difference; and patients compared to the control group the positive rate of -HCV subtypes of lymphoma and anti, also found no statistically significant difference. In righteousness. And in 2006 the country HCV seroepidemiological survey results, male five extrahepatic tumor positive rate of anti -HCV and the data comparison, differences were no obvious statistical significance. In women, breast cancer, thyroid cancer, kidney and pancreatic cancer compared with anti -HCV positive rate and the data difference there is no statistically significant, while chronic lymphocytic leukemia / lymphoma subtypes in small lymphocyte anti -HCV positive rate was 5.56%, compared with the national data significantly differences were statistically significant (P=0.001). Conclusion: 1, non Hodgkin's lymphoma and its subtypes, and HBV pancreatic cancer such as.2 infection existed certain correlation. Diffuse infection in non HBV infected patients with HBV large B cell lymphoma, sex and age distribution showed no significant difference between.3 and female patients with chronic lymphocytic leukemia / small lymphocytic lymphoma There is a certain correlation with HCV infection.

【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R512.6

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