本文選題：散發(fā)性 + 戊型肝炎�。� 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:戊型肝炎病毒(Hepatitis E virus,HEV)是引起急性戊型肝炎(Acute Hepatitis E,AHE)的病原體,目前已成為公共衛(wèi)生領(lǐng)域的關(guān)注的熱點(diǎn)問(wèn)題,主要有暴發(fā)流行和散發(fā)兩種傳播形式,本次研究探討我院散發(fā)性戊型病毒性肝炎流行病學(xué)和臨床特征,分析AHE組、AHE重疊慢性肝病以及老年AHE患者的臨床特點(diǎn)及相關(guān)因素,為進(jìn)一步的研究提供依據(jù)。方法:收集安徽醫(yī)科大學(xué)第一附屬醫(yī)院2012年1月-2015年12月在感染病科住院的156例散發(fā)性急性戊型肝炎的患者的臨床資料和數(shù)據(jù),并按照如下方法進(jìn)行分組比較和分析:1.按照患者感染的形式分組,將感染HEV患者分為AHE組和AHE重疊慢性肝病組,其中慢性肝病中包括慢性乙型病毒性肝炎,酒精性肝病,乙型肝炎后肝硬化,分別比較這三類(lèi)人群與AHE組的異同;2.按照患者年齡層次劃分,分為非老年組(年齡60歲)和老年組(年齡≥60歲),分析兩組數(shù)據(jù)之間的不同以及影響老年戊肝患者病程的相關(guān)因素。3.應(yīng)用多元線性回歸分析方法分析戊型肝炎淤膽的相關(guān)因素及影響住院時(shí)間的相關(guān)因素。1.按照患者感染的形式分組,將感染HEV患者分為AHE組和AHE重疊慢性肝病組,其中慢性肝病中包括慢性乙型病毒性肝炎,酒精性肝病,乙型肝炎后肝硬化,分別比較這三類(lèi)人群與AHE組的異同;2.按照患者年齡層次劃分,分為非老年組(年齡60歲)和老年組(年齡≥60歲),分析兩組數(shù)據(jù)之間的不同以及影響老年戊肝患者病程的相關(guān)因素。3.應(yīng)用多元線性回歸分析方法分析戊型肝炎淤膽的相關(guān)因素及影響住院時(shí)間的相關(guān)因素。結(jié)果1.本次研究我院156例戊型病毒性肝炎中,男性129例,女性27例,男:女為4.7:1;年齡14~79歲,平均年齡為(52.9±12.7)歲;戊型肝炎全年散發(fā),發(fā)病時(shí)節(jié)以春季(1-3月)發(fā)病例數(shù)例數(shù)居多(n=66,42.30%),單月以2月份高發(fā)(32/156,20.51%);發(fā)病患者的職業(yè)特征中,從事務(wù)農(nóng)務(wù)工占共計(jì)124例(79.48%),其他職業(yè)32例(20.51%)。發(fā)病區(qū)域特點(diǎn):農(nóng)村患者105例(67.30%),城市患者51例(32.69%)。2.臨床分型中,急性黃疸型135例(86.53%),無(wú)黃疸型21例(13.46%),急性淤膽型肝炎72例(46.15%),重型肝炎11例(7.05%);感染形式中,單純AHE組78例(50.00%),AHE合并慢性肝病共78例(50.00%),其中AHE重疊慢性乙型肝炎感染20例(12.82%),AHE合并酒精性肝病共37例(23.71%),AHE重疊乙肝肝硬化21例(13.46%);1.本次研究我院156例戊型病毒性肝炎中,男性129例,女性27例,男:女為4.7:1;年齡14~79歲,平均年齡為(52.9±12.7)歲;戊型肝炎全年散發(fā),發(fā)病時(shí)節(jié)以春季(1-3月)發(fā)病例數(shù)例數(shù)居多(n=66,42.30%),單月以2月份高發(fā)(32/156,20.51%);發(fā)病患者的職業(yè)特征中,從事務(wù)農(nóng)務(wù)工占共計(jì)124例(79.48%),其他職業(yè)32例(20.51%)。發(fā)病區(qū)域特點(diǎn):農(nóng)村患者105例(67.30%),城市患者51例(32.69%)。2.臨床分型中,急性黃疸型135例(86.53%),無(wú)黃疸型21例(13.46%),急性淤膽型肝炎72例(46.15%),重型肝炎11例(7.05%);感染形式中,單純AHE組78例(50.00%),AHE合并慢性肝病共78例(50.00%),其中AHE重疊慢性乙型肝炎感染20例(12.82%),AHE合并酒精性肝病共37例(23.71%),AHE重疊乙肝肝硬化21例(13.46%);3.年齡層次分布中,非老年組(年齡60歲)共計(jì)99例,其中青年組(40歲)17例(10.89%),中年組(41~59歲)82例(52.56%),老年組(≥60歲)共計(jì)57例(36.54%),年齡層次主要分布在中年人群;4.AHE重疊慢性肝病中,以AHE合并酒精性肝病例數(shù)最多(37/78,47.43%),AHE重疊慢性乙型病毒性肝炎膽紅素高峰水平明顯高于單純感染組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),白蛋白、ALT/AST比值、TBA和PT水平未見(jiàn)明顯差異;AHE重疊乙肝肝硬化組,白蛋白、ALT/AST比值低于單純AHE組,TBA及PT水平高于單純感染組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);5.老年AHE患者組平均住院時(shí)間及黃疸高峰值大于非老年組,白蛋白及ALT/AST比值低于非老年組,老年組發(fā)生重型肝炎的幾率大于非老年組,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05);6.本次對(duì)住院時(shí)間大于三周以上(住院天數(shù)≥21天)的患者一共50例,利用多元線性回歸方程顯示住院時(shí)間與性別、年齡、ALB、GLB、TBIL、ALT、TBA成正性相關(guān)關(guān)系,與AST、ALP、PT和PTA成負(fù)性相關(guān)關(guān)系。性別,年齡,入院時(shí)TBIL值和ALT/AST比值是影響住院時(shí)間的相關(guān)因素。結(jié)論1.本院2012年至2015年156例急性戊型肝炎患者中,均為散發(fā),未見(jiàn)群體發(fā)病,男性發(fā)病率高于女性,發(fā)病年齡段主要集中在中年人群;2.單純AHE以急性黃疸型肝炎多見(jiàn),AHE合并慢性肝病較單純AHE組病情重,其中以AHE合并酒精性肝病患者居多,而AHE重疊慢性乙型肝炎及乙型肝炎肝硬化患者住院時(shí)間延長(zhǎng),易發(fā)生多種并發(fā)癥,重型肝炎發(fā)生率增加,影響病情恢復(fù);3.老年AHE患者容易合并淤膽,發(fā)生重型肝炎的幾率高,恢復(fù)時(shí)間長(zhǎng),需注意老年AHE患者病情重,應(yīng)給予密切關(guān)注;4.男性,年齡,膽紅素高峰,入院時(shí)ALT/AST比值和PT值是影響住院時(shí)間的相關(guān)因素。1.本院2012年至2015年156例急性戊型肝炎患者中,均為散發(fā),未見(jiàn)群體發(fā)病,男性發(fā)病率高于女性,發(fā)病年齡段主要集中在中年人群;2.單純AHE以急性黃疸型肝炎多見(jiàn),AHE合并慢性肝病較單純AHE組病情重,其中以AHE合并酒精性肝病患者居多,而AHE重疊慢性乙型肝炎及乙型肝炎肝硬化患者住院時(shí)間延長(zhǎng),易發(fā)生多種并發(fā)癥,重型肝炎發(fā)生率增加,影響病情恢復(fù);3.老年AHE患者容易合并淤膽,發(fā)生重型肝炎的幾率高,恢復(fù)時(shí)間長(zhǎng),需注意老年AHE患者病情重,應(yīng)給予密切關(guān)注;4.男性,年齡,膽紅素高峰,入院時(shí)ALT/AST比值和PT值是影響住院時(shí)間的相關(guān)因素。
[Abstract]:Objective: Hepatitis E virus (HEV) is the pathogen causing acute hepatitis E (Acute Hepatitis E, AHE). At present, it has become a hot issue in the public health field. It mainly has two forms of epidemic and dissemination. This study explored the epidemiological and clinical characteristics of sporadic HEV hepatitis in our hospital. The clinical characteristics and related factors of AHE group, AHE overlapping chronic liver disease and elderly AHE patients were analyzed. Methods: the clinical data and data of 156 patients with acute sporadic hepatitis E in the First Affiliated Hospital of Medical University Of Anhui in December January 2012 -2015 were collected and the clinical data and data were collected. Subgroup comparison and analysis: 1. according to the form of patient infection group, the HEV patients were divided into AHE group and AHE overlapping chronic liver disease group. Chronic liver disease included chronic hepatitis B, alcoholic liver disease, and hepatitis B cirrhosis, compared the similarities and differences between the three groups and the AHE group; 2. according to the age level of the patients. Classification, divided into non aged group (age 60) and aged group (age > 60 years old), analysis of the difference between the two groups of data and the related factors affecting the course of disease in the elderly patients with hepatitis E,.3. applied multivariate linear regression analysis to analyze the related factors of cholestasis of hepatitis E and the related factors affecting the time of residence,.1. according to the form of patient infection. The patients with HEV were divided into AHE group and AHE overlapping chronic liver disease group. Chronic liver disease included chronic hepatitis B, alcoholic liver disease, and hepatitis B cirrhosis, compared the similarities and differences between the three groups and the AHE group, and 2. according to the age level of the patients, they were divided into non aged group (age 60 years old) and old group (age 60 years old), Analysis of the differences between the two groups of data and the related factors affecting the course of the elderly patients with hepatitis E,.3. applied multivariate linear regression analysis to analyze the related factors of cholestasis of hepatitis E and the related factors affecting the time of hospitalization. Results 1. in 156 cases of hepatitis E virus hepatitis in our hospital, 129 cases were male, 27 women were female, male was 4.7:1; Age 14~79 years, the average age was (52.9 + 12.7) years; hepatitis E was distributed throughout the year. The number of cases in spring (1-3 months) was most (n=66,42.30%), and the month was high in February (32/156,20.51%). Among the occupational characteristics of the patients, 124 cases (79.48%) and 32 other occupations (20.51%). The village patients were 105 (67.30%), 51 (32.69%).2. clinical classification, 135 cases of acute jaundice (86.53%), 21 cases without jaundice (13.46%), 72 cases of acute cholestatic hepatitis (46.15%), 11 cases of severe hepatitis (7.05%). In the form of infection, there were 78 cases in group AHE, AHE combined with chronic liver disease, of which AHE overlapped chronic hepatitis B Infection in 20 cases (12.82%), AHE with alcoholic liver disease in 37 cases (23.71%), AHE overlapped hepatitis B cirrhosis in 21 cases (13.46%); 1. in our hospital 156 cases of hepatitis E virus hepatitis, male 129 cases, 27 women, male: 4.7:1, age 14~79 years, average age of (52.9 + 12.7) years, hepatitis E all the year out, the onset of disease in the spring (1-3 months) onset The number of cases (n=66,42.30%) and high incidence of February (32/156,20.51%); among the occupational characteristics of the patients, 124 cases (79.48%), 32 cases (20.51%) of other occupations, 105 cases (67.30%) of rural patients, 51 cases of urban patients (32.69%).2. clinical classification, 135 (86.53%) with acute jaundice (86.53%), no jaundice. There were 21 cases (13.46%), 72 cases of acute cholestatic hepatitis (46.15%), 11 cases of severe hepatitis (7.05%), 78 cases in AHE group (50%), 78 patients with chronic liver disease (50%), AHE with chronic hepatitis B infection (12.82%), AHE combined with alcoholic liver disease (23.71%), AHE overlapped hepatitis B cirrhosis. In the hierarchical distribution, there were 99 cases in the non aged group (age 60), of which 17 (10.89%) in the young group (10.89%), 82 (52.56%) in the middle age group (41~59 years) and 57 (36.54%) in the elderly group (36.54%), and the age level was mainly in the middle age group; in the 4.AHE overlapping slow liver disease, the number of AHE combined with alcoholic liver disease was the most (37/78,47.43%) and AHE overlapped the chronic chronic disease. The peak level of bilirubin in viral hepatitis B was significantly higher than that in simple infection group (P0.05), and there was no significant difference in the level of albumin, ALT/AST, TBA and PT. The ratio of albumin and ALT/AST in AHE overlapped hepatitis B liver cirrhosis group was lower than that in pure AHE group, and the level of TBA and PT was higher than that of the simple infection group (P0., P0.). The difference was statistically significant (P0.). 05): 5. the average length of hospitalization and jaundice in the elderly AHE patients were higher than those in the non elderly group, and the ratio of albumin to ALT/AST was lower than that in the non elderly group. The incidence of severe hepatitis in the elderly group was greater than that in the non elderly group (P0.05); the 6. patients with more than three weeks of hospitalization more than three weeks (hospitalization days more than 21 days) had 50 cases. Multiple linear regression equations were used to show the positive correlation between hospitalization time and sex, age, ALB, GLB, TBIL, ALT, TBA, and negative correlation with AST, ALP, PT and PTA. Sex, age, TBIL value and ALT/AST ratio at admission were related factors affecting the time of hospitalization. Conclusion 1. patients with acute hepatitis E from 2012 to 2015 in our hospital were 156 cases, There were no group morbidity, male incidence was higher than that of women, age of onset mainly concentrated in middle age group; 2. simple AHE with acute jaundice hepatitis, AHE combined with chronic liver disease more severe than simple AHE group, among which AHE combined alcoholic liver disease patients were most, and AHE overlapped chronic hepatitis B and hepatitis B cirrhosis patients. The prolonged hospitalization time is easy to have a variety of complications, the incidence of severe hepatitis is increased and the condition of the disease is restored. 3. elderly AHE patients are easy to merge with cholestasis, high probability of severe hepatitis and long recovery time. We should pay close attention to the condition of elderly AHE patients and should pay close attention; 4. male sex, age, peak of bilirubin, ALT/AST ratio and PT value at admission are shadow. Related factors of the time of hospitalization.1. in our hospital from 2012 to 2015, 156 cases of acute hepatitis E were sporadic, and there was no group disease. The incidence of male was higher than that of women. The age of the disease was mainly concentrated in the middle age group; 2. simple AHE with acute jaundice hepatitis, AHE combined with chronic liver disease more severe than that of the simple AHE group, which was combined with AHE. There are many patients with alcoholic liver disease, while AHE overlaps with chronic hepatitis B and hepatitis B liver cirrhosis in patients with prolonged hospitalization, many complications are easy to occur, the incidence of severe hepatitis is increased, and the condition of 3. elderly AHE patients is easy to merge with cholestasis, the chances of severe hepatitis are high, and the time of recovery is long, so it is necessary to pay attention to the serious condition of the elderly AHE patients. Should pay attention to the condition of the elderly patients. Close attention was given; 4. men, age, peak of bilirubin, ALT/AST ratio at admission and PT were related factors of hospitalization time.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R512.6

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 高慧;林鋒;吳彪;肖芙蓉;;重型戊型病毒性肝炎合并格林-巴利綜合征一例[J];海南醫(yī)學(xué);2016年13期

2 包葉江;高孟;姜立民;姜慧芬;羅永能;;中國(guó)2004-2013年戊型肝炎的流行病學(xué)特征分析[J];國(guó)際流行病學(xué)傳染病學(xué)雜志;2016年01期

3 耿家寶;王敏;劉倩楠;董源;徐靜;李平;謝芳;盛云峰;鄭文凱;汪茂榮;;我國(guó)東部地區(qū)戊型肝炎的流行病學(xué)特點(diǎn)[J];肝臟;2016年01期

4 王貴強(qiáng);王福生;成軍;任紅;莊輝;孫劍;李蘭娟;李杰;孟慶華;趙景民;段鐘平;侯金林;賈繼東;唐紅;盛吉芳;彭R，

本文編號(hào)：1803528