Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Department of Internal Medicine, Hallym Univesity College of Medicine, Hallym Univesity Kangnam Sacred Heart Hospital, Seoul, Korea.
J Korean Med Sci. 2014 Feb;29(2):248-53. doi: 10.3346/jkms.2014.29.2.248. Epub 2014 Jan 28.
The aim of this study was to investigate the clinical characteristics of acute hepatitis A during a recent outbreak in Korea. Data of patients diagnosed with acute hepatitis A from 2007 to 2009 were collected from 21 tertiary hospitals retrospectively. Their demographic, clinical, and serological characteristics and their clinical outcomes were analyzed. A total of 4,218 patients (mean age 33.3 yr) were included. The median duration of admission was 9 days. The mean of the highest ALT level was 2,963 IU/L, total bilirubin was 7.3 mg/dL, prothrombin time INR was 1.3. HBsAg was positive in 3.7%, and anti-HCV positive in 0.7%. Renal insufficiency occurred in 2.7%, hepatic failure in 0.9%, relapsing hepatitis in 0.7%, and cholestatic hepatitis in 1.9% of the patients. Nineteen patients (0.45%) died or were transplanted. Complications of renal failure or prolonged cholestasis were more frequent in patients older than 30 yr. In conclusion, most patients with acute hepatitis A recover uneventfully, however, complication rates are higher in patients older than 30 yr than younger patients. Preventive strategies including universal vaccination in infants and active immunization of hepatitis A to adult population should be considered for prevention of community-wide outbreaks of hepatitis A in Korea.
本研究旨在探讨韩国近期甲型肝炎爆发期间的急性肝炎临床特征。回顾性收集了 21 家三级医院 2007 年至 2009 年确诊为急性甲型肝炎的患者数据。分析了他们的人口统计学、临床和血清学特征以及临床结局。共纳入 4218 例患者（平均年龄 33.3 岁）。中位住院时间为 9 天。最高 ALT 水平的平均值为 2963IU/L，总胆红素为 7.3mg/dL，凝血酶原时间 INR 为 1.3。HBsAg 阳性率为 3.7%，抗 HCV 阳性率为 0.7%。肾功能不全发生率为 2.7%，肝衰竭发生率为 0.9%，复发型肝炎发生率为 0.7%，淤胆型肝炎发生率为 1.9%。19 例（0.45%）患者死亡或接受了肝移植。30 岁以上患者的肾功能衰竭或长期胆汁淤积并发症更为常见。总之，大多数急性甲型肝炎患者恢复顺利，但 30 岁以上患者的并发症发生率高于年轻患者。应考虑在韩国实施针对婴幼儿的普遍疫苗接种和针对成年人群的甲型肝炎主动免疫等预防策略，以预防甲型肝炎的社区爆发。
