急性戊型肝炎重度黄疸的临床特征及危险因素。
Clinical features and risk factors of acute hepatitis E with severe jaundice.
机构信息
Liver and Endocrine Diseases Ward of Beijing Youan Hospital, Capital Medical University, Beijing 100069, China.
出版信息
World J Gastroenterol. 2012 Dec 28;18(48):7279-84. doi: 10.3748/wjg.v18.i48.7279.
AIM
To compares the clinical features of patients infected with hepatitis E virus (HEV) with or without severe jaundice. In addition, the risk factors for HEV infection with severe jaundice were investigated.
METHODS
We enrolled 235 patients with HEV into a cross-sectional study using multi-stage sampling to select the study group. Patients with possible acute hepatitis E showing elevated liver enzyme levels were screened for HEV infection using serologic and molecular tools.HEV infection was documented by HEV antibodies and by the detection of HEV-RNA in serum. We used χ(2) analysis, Fisher's exact test, and Student's t test where appropriate in this study. Significant predictors in the univariate analysis were then included in a forward, stepwise multiple logistic regression model.
RESULTS
No significant differences in symptoms, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, or hepatitis B virus surface antigen between the two groups were observed. HEV infected patients with severe jaundice had significantly lower peak serum levels of γ-glutamyl-transpeptidase (GGT) (median: 170.31 U/L vs 237.96 U/L, P = 0.007), significantly lower ALB levels (33.84 g/L vs 36.89 g/L, P = 0.000), significantly lower acetylcholine esterase (CHE) levels (4500.93 U/L vs 5815.28 U/L, P = 0.000) and significantly higher total bile acid (TBA) levels (275.56 μmol/L vs 147.03 μmol/L, P = 0.000) than those without severe jaundice. The median of the lowest point time tended to be lower in patients with severe jaundice (81.64% vs 96.12%, P = 0.000). HEV infected patients with severe jaundice had a significantly higher viral load (median: 134 vs 112, P = 0.025) than those without severe jaundice. HEV infected patients with severe jaundice showed a trend toward longer median hospital stay (38.17 d vs 18.36 d, P = 0.073). Multivariate logistic regression indicated that there were significant differences in age, sex, viral load, GGT, albumin, TBA, CHE, prothrombin index, alcohol overconsumption, and duration of admission between patients infected with acute hepatitis E with and without severe jaundice.
CONCLUSION
Acute hepatitis E patients may naturally present with severe jaundice.
目的
比较伴有和不伴有重度黄疸的戊型肝炎病毒（HEV）感染患者的临床特征。此外，还调查了伴有重度黄疸的 HEV 感染的危险因素。
方法
我们使用多阶段抽样对 235 例 HEV 患者进行了一项横断面研究，选择研究组。使用血清学和分子工具筛选出可能患有急性戊型肝炎且肝酶水平升高的患者，以检测 HEV 感染。通过 HEV 抗体和血清中 HEV-RNA 的检测确定 HEV 感染。本研究中使用了 χ(2)分析、Fisher 确切检验和学生 t 检验。然后，将单变量分析中的显著预测因素纳入向前逐步多因素逻辑回归模型。
结果
两组患者在症状、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶或乙型肝炎病毒表面抗原方面无显著差异。伴有重度黄疸的 HEV 感染患者的γ-谷氨酰转肽酶（GGT）峰值血清水平明显较低（中位数：170.31 U/L 比 237.96 U/L，P = 0.007），白蛋白（ALB）水平明显较低（33.84 g/L 比 36.89 g/L，P = 0.000），乙酰胆碱酯酶（CHE）水平明显较低（4500.93 U/L 比 5815.28 U/L，P = 0.000），总胆汁酸（TBA）水平明显较高（275.56 μmol/L 比 147.03 μmol/L，P = 0.000）。伴有重度黄疸的患者的最低点时间中位数倾向于更低（81.64% 比 96.12%，P = 0.000）。伴有重度黄疸的 HEV 感染患者的病毒载量明显较高（中位数：134 比 112，P = 0.025）。伴有重度黄疸的 HEV 感染患者的中位住院时间较长（38.17 d 比 18.36 d，P = 0.073）。多变量逻辑回归表明，伴有和不伴有重度黄疸的急性戊型肝炎患者在年龄、性别、病毒载量、GGT、白蛋白、TBA、CHE、凝血酶原指数、酒精过量摄入和住院时间方面存在显著差异。
结论
急性戊型肝炎患者可能会自然出现重度黄疸。
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