本文選題：肝病 + 臨床��； 參考：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：第一部分肝臟疾病臨床流行趨勢及相關(guān)因素研究 目的：通過住院病例疾病譜分析，探明肝病臨床流行學(xué)特征及變化趨勢，為高發(fā)、多發(fā)及危重肝病的防治提供參考依據(jù)。 方法：收集2005年、2009年、2013年河北醫(yī)科大學(xué)第三醫(yī)院中西醫(yī)肝病科住院病人的病例資料。記錄一般情況、化驗、檢查指標(biāo)，使用SPSS17.0統(tǒng)計處理，統(tǒng)計方法采用卡方檢驗和方差分析。描述性分析3年肝病流行特征,并對比分析3年疾病譜的變化趨勢，進一步探討其發(fā)病和轉(zhuǎn)歸的相關(guān)因素。 結(jié)果：結(jié)果表明，2005年幾類常見肝病占收治病人的比例（例數(shù)/總例數(shù)）分別是乙型病毒性肝炎（簡稱乙肝）58.88%（179/304），脂肪性肝病12.50%（38/304），丙型病毒性肝炎（簡稱丙肝）8.55%（26/304），藥物性肝損傷（簡稱藥肝）2.30%（7/304）；2009年分別是乙肝53.98%（271/502），脂肪性肝病22.14%（60/502），丙肝20.76%（54/502），藥物性肝損傷9.56%（48/502）；2013年分別是乙肝53.41%（298/558），丙肝13.98%（78/558），藥物性肝損傷11.83%（66/558），脂肪性肝病8.42%（47/558）。乙肝占收治肝病的主要部分，丙型病毒性肝炎、藥物性肝損傷的比例逐年上升，3年丙肝、藥肝所占比例變化有統(tǒng)計學(xué)意義，分別是丙肝（χ2=6.187，P=0.045）和藥肝（χ2=22.556，P=0.000）。乙肝、脂肪性肝病在性別分布上，男性多于女性，分別是2005年、2009年、2013年乙肝比例（男：女）2.8:1，2.5:1，3.2:1；脂肪性肝病（男：女）11.7:1，4:1，5.7:1。而丙肝、藥肝近年女性多于男性，2013年丙肝（男：女）1:1.6，藥肝（男：女）1:1.44，其中丙肝3年女性比例變化（2005年，3.95%；2009年，3.78%；2013年，13.98%）有統(tǒng)計學(xué)意義（χ2=13.678，P=0.001），藥肝男（2005年，1.32%；2009年，4.98%；2013年，4.84%）女（2005年，0.99%；2009年，4.58%；2013年，6.99%）比例變化均有統(tǒng)計學(xué)意義，分別是男性（χ2=7.747，P=0.021）和女性（χ2=15.682，P=0.000）。職業(yè)分布上，干部比例逐漸減少，農(nóng)民比例逐漸上升，其中乙肝中干部（2005年，38.55%；2009年，25.46%；2013年，18.18%）（χ2=27.654，P=0.000）、工人（2005年，8.38%；2009年，14.76%；2013年，7.38%）（χ2=8.411，P=0.015），丙肝中干部（2005年，57.69%；2009年，40.74%；2013年，20.51%）（χ2=13.998，P=0.001），藥肝中工人（2005年，0.00%；2009年，31.25%；2013年，33.33%）（χ2=6.198，P=0.045）的比例變化均有統(tǒng)計學(xué)意義。年齡分布上，住院乙肝病人年齡集中在40~49歲和50~59歲兩個年齡段，2009年與2013年年齡變化具有統(tǒng)計學(xué)意義（P=0.023）；丙肝病人集中在50~59歲和60~69兩個年齡段，2005年、2009年、2013年年齡變化均具有統(tǒng)計學(xué)意義（2005vs2009，P1=0.002；2005vs2013，P2=0.000；2009vs2013，P3=0.000）；脂肪性肝病病人集中在40~49歲和50~59歲；藥物性肝病病人集中在40~49歲，2005年、2009年、2013年年齡變化均具有統(tǒng)計學(xué)意義（2005vs2009，P1=0.003；2005vs2013，P2=0.000；2009vs2013，P3=0.005）。 結(jié)論： 總體上乙肝仍然占收治肝病的主要部分，丙肝、藥肝的比例逐年上升。農(nóng)民占住院病人的比例所占比例越來越大，干部比例越來越小。 1中國乙肝患者數(shù)量依然很龐大，需要給予關(guān)注并積極預(yù)防，，發(fā)病年齡集中在中年，男性發(fā)病患者多于女性，且大部分人可接受抗病毒治療。乙肝的防治、診療水平有大幅度提升。 2收治的丙肝病人中，近年性別上女性多于男性。丙肝發(fā)病較晚，發(fā)病年齡偏中老年。 3脂肪性肝病中，近幾年酒精性肝病的比例在上升。男女比例上，男性遠遠多于女性。發(fā)病年齡偏中青年，要加強飲食控制、嚴格限酒方面的宣傳。 4藥物性肝病中，近年收治的女性患者多于男性，年齡上偏中年。藥肝的發(fā)病率、死亡率逐年上升，需要引起人們的關(guān)注。 第二部分γ谷氨酰胺轉(zhuǎn)肽酶與慢性乙型肝炎炎癥及纖維化相關(guān)性研究 目的：分析γ谷氨酰胺轉(zhuǎn)肽酶（GGT）與慢性乙型肝炎病人肝組織病理纖維化及炎癥分級之間的相關(guān)性，明確GGT數(shù)值大小是否可以用來預(yù)測慢性乙型肝炎患者肝臟纖維化、炎癥的程度。 方法：收集2007年至2013年初河北醫(yī)科大學(xué)第三醫(yī)院中西醫(yī)肝病科乙肝病人肝穿病理資料，嚴格按照排除標(biāo)準和入選標(biāo)準，整理單純乙肝病人的病理資料數(shù)據(jù)，分別按炎癥程度由輕到重，分為G0-1（包括G0，G0-1，G1）、G1-2（包括G1+，G2-，G1-2，G2），G2-3（包括G2+，G2-3，G3），G3-4（包括G3+，G3-4，G4）4個組，按纖維化程度分為S0-1（包括S0，S0-1，S1），S1-2(包括S1+，S2-，S1-2，S2)，S2-3(包括S2+，S2-3，S3)，S3-4(包括S3+，S3-4，S4)。應(yīng)用Excel表和SPSS17.0統(tǒng)計軟件對數(shù)據(jù)進行整理、分析。 結(jié)果：排除其他合并癥，單純乙型肝炎病理資料共計192例，其中男性141例，女性51例，男女比例2.8:1；平均年齡33.11±12.10；按纖維化分級，S0-1、S1-2、S2-3、S3-4的病例數(shù)分別為：77、56、30、29，GGT均值±標(biāo)準差分別為：25.26±19.11、27.64±23.6、71±60.37、86.07±60.28U/L，其中S0-1、S2-3，S0-1、S3-4，S1-2、S2-3，S1-2、S3-4之間GGT有統(tǒng)計學(xué)意義（P＜0.05），S0-1、S1-2間GGT無統(tǒng)計學(xué)意義；按炎癥分級，G0-1、G1-2、G2-3、G3-4的病例數(shù)分別為：60、84、36、2，G0-1、G1-2、G2-3的GGT均值±標(biāo)準差分別為：20.65±8.64，38.00±45.39，109.73±67.72U/L，其中G0-1、G2-3以及G1-2、G2-3之間差異顯著，（P＜0.05），G0-1、G1-2間GGT無統(tǒng)計學(xué)意義。 結(jié)論： 1因診療需求進行肝穿患者中，以青年為主，男性多于女性。 2血清GGT水平與乙型肝炎炎癥活動度及纖維化程度相關(guān)，可能作為預(yù)測炎癥及肝纖維化程度的標(biāo)志之一。
[Abstract]:Part 1 clinical trends and related factors of liver diseases
Objective: To explore the clinical epidemiological characteristics and trend of liver disease through the analysis of the disease spectrum of hospitalized cases, so as to provide reference for the prevention and treatment of high incidence, multiple and critical liver diseases.
Methods: the data of hospitalized patients in the Third Hospital of Hebei Medical University, 2005, 2009 and 2013 were collected. The general situation, test, examination index, SPSS17.0 statistical processing, chi square test and variance analysis were used. The epidemiological characteristics of 3 years of liver disease were descriptive and analyzed, and the changes of the 3 year disease spectrum were compared and analyzed. The related factors of morbidity and prognosis were further explored.
Results: the results showed that the proportion of common liver diseases in 2005 was 58.88% (179/304), 12.50% (38/304), 8.55% (26/304), 2.30% (7/304) for hepatitis C, 2.30% (7/304), and 53 of hepatitis B in 2009, respectively. .98% (271/502), fatty liver disease 22.14% (60/502), hepatitis C 20.76% (54/502), drug induced liver injury 9.56% (48/502); in 2013, hepatitis B 53.41% (298/558), hepatitis C 13.98% (78/558), drug induced liver injury 11.83% (66/558), fatty liver disease 8.42% (47/558). Hepatitis B is the main part of liver disease, hepatitis C and drug-induced liver injury. The proportion of the hepatitis C was increased year by year, the proportion of the 3 years of hepatitis C was statistically significant, and they were hepatitis C (x 2=6.187, P=0.045) and drug liver (x 2=22.556, P=0.000). The sex distribution of hepatitis B and fatty liver disease were more than women in 2005, 2009, and 2013 (male: female), respectively, and fatty liver disease (male: Women) 11.7:1,4:1,5.7:1. and hepatitis C, drug liver in recent years more women than men, 2013 hepatitis C (male: female) 1:1.6, drug liver (male: female) 1:1.44, in which 3 years of hepatitis C (2005, 3.95%; 2009, 3.78%; 2013, 13.98%) have statistical significance (2= 13.678, P=0.001), medicine liver male (2005, 1.32%; 2009, 2009, 2013, 2013, 4.84%) women (20 05 years, 0.99%, 2009, 4.58%, 2013, 6.99%) were statistically significant, respectively, men (x 2=7.747, P=0.021) and women (x 2=15.682, P=0.000). Occupational distribution, the proportion of cadres gradually decreased, the proportion of farmers gradually increased, of which hepatitis B (2005, 38.55%; 2009, 25.46%; 2013, 18.18%) (x 2=27.654, P=0.000) Workers (2005, 8.38%; 2009, 14.76%; 2013, 7.38%) (chi 2=8.411, P=0.015), cadres in hepatitis C (2005, 57.69%; 2009, 40.74%; 2013, 20.51%) (x 2=13.998, P=0.001), the proportion of workers in the liver (2005, 0%; 31.25%; 33.33%, 33.33%) (Chi, 2=6.198, 33.33%) were statistically significant. Age distribution, The age of hospitalized patients with hepatitis B was concentrated in two age groups of 40~49 years and 50~59 years. The age changes in 2009 and 2013 were statistically significant (P=0.023). The patients with hepatitis C concentrated in two ages of 50~59 years and 60~69, 2005, 2009, and 2013 were statistically significant (2005vs2009, P1=0.002; 2005vs2013, P2=0.000; 2009vs2013, P. 3=0.000); the patients with fatty liver disease were concentrated at the age of 40~49 and 50~59; the patients with drug-induced liver disease were concentrated at the age of 40~49, in 2005, 2009, and in 2013, the age changes were all statistically significant (2005vs2009, P1=0.003; 2005vs2013, P2=0.000; 2009vs2013, P3=0.005).
Conclusion:
In general, hepatitis B still accounts for the main parts of liver disease. The proportion of hepatitis C and drug liver is increasing year by year. The proportion of farmers in hospitalized patients is increasing, and the proportion of cadres is becoming smaller and smaller.
1 the number of patients with hepatitis B in China is still very large. It needs to pay attention and proactive prevention. The age of the disease is concentrated in middle age, the incidence of male patients is more than that of women, and most people can receive antiviral treatment. The prevention and treatment of hepatitis B and the level of diagnosis and treatment have greatly improved.
2 among the patients with hepatitis C, there were more women than men in recent years.
In 3 fatty liver diseases, the proportion of alcoholic liver disease in recent years is rising. The proportion of men and women is much more than that of women. The age of the disease is more and more middle-aged and young. It is necessary to strengthen the diet control and strictly limit the publicity of the wine.
4 in drug-induced liver disease, in recent years, the number of female patients is more than that of men, and the age is middle-aged. The incidence and mortality of drug-induced liver disease are increasing year by year.
The second part is the relationship between gamma glutamine transpeptidase and inflammation and fibrosis in chronic hepatitis B.
Objective: to analyze the correlation between gamma glutamine transpeptidase (GGT) and the pathological fibrosis and inflammatory classification of liver tissues in patients with chronic hepatitis B, and to determine whether the value of GGT can be used to predict the degree of liver fibrosis and inflammation in patients with chronic hepatitis B.
Methods: the pathological data of liver puncture of hepatitis B patients in the Third Hospital of Hebei Medical University from 2007 to early 2013 were collected, and the pathological data of patients with simple hepatitis B were arranged strictly according to the standard of exclusion and admission. According to the degree of inflammation, they were divided into G0-1 (including G0, G0-1, G1), G1-2 (including G1+, G2-, G1-2, G2), G2-3 (package). G2+, G2-3, G3), G3-4 (including G3+, G3-4, G4), are divided into S0-1 (including S0, S0-1, S1) according to the degree of fibrosis (including S0, S0-1, S1).
Results: excluding other complications, there were 192 cases of simple hepatitis B pathological data, including 141 males and 51 females, the ratio of male and female was 2.8:1, the average age was 33.11 + 12.10. The number of S0-1, S1-2, S2-3, S3-4 were respectively 77,56,30,29 and GGT mean standard deviation was 25.26 + 19.11,27.64 + 23.6,71 + 60.37,86.07 respectively. S0-1, S2-3, S0-1, S3-4, S1-2, S2-3, S1-2, S3-4 GGT have statistical significance (P < 0.05). There was a significant difference between -1, G2-3 and G1-2, G2-3 (P < 0.05), GGT between G0-1 and G1-2 was not statistically significant.
Conclusion:
1 among the patients with liver disease, the majority of them were young people, more men than women.
2 serum GGT level is correlated with the degree of inflammation and fibrosis of hepatitis B, and may be used as a marker of inflammation and liver fibrosis.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R575

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本文編號：1859738