酒精性肝硬化与乙型肝炎后肝硬化患者的临床特征对比分析

Comparative analysis of the clinical characteristics between the patients with alcoholic cirrhosis and hepatitis B cirrhosis

关键词:  酒精性肝硬化  乙型肝炎后肝硬化  临床表现  并发症

Key words:  alcoholic cirrhosis  hepatitis B cirrhosis  clinical manifestations  complications

摘要:

目的　探讨酒精性肝硬化（alcoholic cirrhosis,AC）与乙型肝炎后肝硬化（hepatitis B cirrhosis,HBC）及酒精合并乙型肝炎后肝硬化（AC+HBC）在临床表现、实验室检查结果及并发症等方面的差异。方法　收集2013年1月至2017年12月于大连医科大学附属第一医院住院首次诊断的356例肝硬化患者的临床资料，其中男292例，女64例，年龄（56.33±10.89）岁。按病因分为AC组81例，HBC组220例，AC+HBC组55例。分析比较三组肝硬化患者一般情况、临床表现、肝功能指标及并发症发生情况。结果　AC组患者腹胀、肝掌、蜘蛛痣、黄疸、腹水、腹壁静脉曲张的发生率均高于HBC组，而右上腹痛的发生率低于HBC组(P＜0.05）。AC+HBC组患者腹水、腹壁静脉曲张的发生率均低于AC组(P＜0.05）。AC+HBC组患者蜘蛛痣、黄疸的发生率均高于HBC组(P＜0.05）。AC组和AC+HBC组患者的天冬氨酸转移酶（AST）、γ-谷氨酰转移酶（GGT）、总胆红素（TBIL）、总胆汁酸（TBA）及天冬氨酸转移酶/丙氨酸转移酶（AST/ALT）比值均较HBC组高，而白蛋白（ALB）均较HBC组低(P＜0.05）。AC+HBC组患者AST较AC组高(P＜0.05）。AC组患者上消化道出血的发生率高于HBC组(P＜0.05），HBC组和AC+HBC组患者肝细胞癌的发生率均高于AC组（P＜0.05）。结论　AC和HBC患者在临床表现、肝功能指标等方面均存在一定差异，应该根据各自的特点采取相应的防治措施。

Abstract:

Objective　To investigate the differences in clinical manifestations, laboratory findings and complications among alcoholic cirrhosis (AC), hepatitis B cirrhosis (HBC) and combined alcoholic and hepatitis B cirrhosis (AC+HBC). 　Methods　The clinical data of 356 patients with cirrhosis who were diagnosed for the first time in the First Affiliated Hospital of Dalian Medical University from January 2013 to December 2017 were collected, including 292 males and 64 females, with a mean age of （56.33±10.89） years old. There were 81 cases in AC group, 220 cases in HBC group and 55 cases in AC+HBC group. The general conditions, clinical manifestations, liver function indexes and complications of the patients in the three groups were analyzed and compared. 　Results　The incidence of abdominal distention, palm of liver, spider nevus, jaundice, ascites and abdominal wall varices were higher in the AC group than those in the HBC group, while the incidence of right upper abdominal pain was lower than that in the HBC group (all P＜0.05). The incidence of ascites and abdominal varices were lower in the AC+HBC group than those in the AC group (both P＜0.05). The incidence of spider nevus and jaundice were higher in the AC+HBC group than those in the HBC group (both P＜0.05). Aspartate aminotransferase (AST), gamma glutamyltransferase (GGT), total bilirubin (TBIL), total bile acid (TBA) and aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio were higher in the AC and AC+HBC groups than those in the HBC group, while albumin (ALB) was lower in both groups (all P＜0.05). AST was higher in the AC+HBC group than that in the AC group (P＜0.05). The incidence of upper gastrointestinal bleeding was higher in the AC group than that in the HBC group (P＜0.05), but the incidence of hepatocellular carcinoma was higher in the HBC and AC+HBC groups than that in the AC group (both P＜0.05). 　Conclusion　There are some differences in clinical manifestations and liver function indexes between patients with AC and HBC, and corresponding prevention and treatment measures should be taken according to their characteristics.