Dai E H, Guo X R, Wang J T, Hu Q G, Li J H, Tang Q Y, Zu H M, Huan H, Wang Y, Gao Y F, Hu G Q, Li W, Liu Z J, Ma Q P, Song Y L, Yang J H, Zhu Y, Huang S D, Meng Z J, Bai B, Chen Y P, Gao C, Huang M X, Jin S Q, Lu M Z, Xu Z, Zhang Q H, Zheng S, Zeng Q L, Qi X L
Division of Liver Disease, the Fifth Hospital of Shijiazhuang, North China University of Science and Technology, Shijiazhuang 050021, China.
School of Public Health, North China University of Science and Technology, Tangshan 063210, China.
Zhonghua Yi Xue Za Zhi. 2023 Mar 28;103(12):913-919. doi: 10.3760/cma.j.cn112137-20221017-02164.
To investigate the etiology, prevention and treatment status, and their corresponding regional differences of the patients with liver cirrhosis in China, in order to provide scientific basis for the development of diagnosis and control strategies in China. Clinical data of patients diagnosed with liver cirrhosis for the first time through January 1, 2018 to December 31, 2020 from 50 hospitals in seven different regions of China were collected and analyzed retrospectively, and the difference of etiology, treatment, and their differences in various regions were analyzed. A total of 11 861 cases with liver cirrhosis were included in the study. Thereinto, 5 093 cases (42.94%) were diagnosed as compensated cirrhosis, and 6 768 cases (57.06%) had decompensated cirrhosis. Notably, 8 439 cases (71.15%) were determined as chronic hepatitis B-caused cirrhosis, 1 337 cases (11.27%) were alcoholic liver disease, 963 cases (8.12%) were chronic hepatitis C, 698 cases (5.88%) were autoimmune liver disease, 367 cases (3.09%) were schistosomiasis, 177 cases (1.49%) were nonalcoholic fatty liver, and 743 cases (6.26%) of other types of liver disease. There were significant differences in the incidence of chronic hepatitis B, chronic hepatitis C, alcoholic liver disease, fatty liver, schistosomiasis liver disease, and autoimmune liver disease among the seven regions (<0.001). Only 1 139 cases (9.60%) underwent endoscopic therapy, thereinto, 718 cases (6.05%) underwent surgical therapy, and 456 cases (3.84%) underwent interventional therapy treatment. In patients with compensated liver cirrhosis, 60 cases (0.51%) underwent non-selective β receptor blockers(NSBB), including 59 cases (0.50%) underwent propranolol and 1 case (0.01%) underwent carvedilol treatment. In patients with decompensated liver cirrhosis, 310 cases (2.61%) underwent NSBB treatment, including 303 cases (2.55%) underwent propranolol treatment and 7 cases (0.06%) underwent carvedilol treatment. Interestingly, there were significant differences in receiving endoscopic therapy, interventional therapy, NSBB therapy, splenectomy and other surgical treatments among the seven regions (<0.001). Currently, chronic hepatitis B is the main cause (71.15%) of liver cirrhosis in several regions of China, and alcoholic liver disease has become the second cause (11.27%) of liver cirrhosis in China. The three-level prevention and control of cirrhosis in China should be further strengthened.
为探讨我国肝硬化患者的病因、防治现状及其地区差异，为我国制定诊断和控制策略提供科学依据。回顾性收集并分析了2018年1月1日至2020年12月31日期间我国七个不同地区50家医院首次诊断为肝硬化的患者的临床资料，分析病因、治疗方法及其在不同地区的差异。本研究共纳入11861例肝硬化患者。其中，5093例（42.94%）被诊断为代偿期肝硬化，6768例（57.06%）为失代偿期肝硬化。值得注意的是，8439例（71.15%）被确定为慢性乙型肝炎所致肝硬化，1337例（11.27%）为酒精性肝病，963例（8.12%）为慢性丙型肝炎，698例（5.88%）为自身免疫性肝病，367例（3.09%）为血吸虫病，177例（1.49%）为非酒精性脂肪性肝病，743例（6.26%）为其他类型肝病。七个地区慢性乙型肝炎、慢性丙型肝炎酒精性肝病、脂肪性肝病、血吸虫性肝病和自身免疫性肝病的发病率存在显著差异（<0.001）。仅1139例（9.60%）接受了内镜治疗，其中718例（6.05%）接受了手术治疗，456例（3.84%）接受了介入治疗。在代偿期肝硬化患者中，60例（0.51%）接受了非选择性β受体阻滞剂（NSBB）治疗，其中59例（0.50%）接受了普萘洛尔治疗，1例（0.01%）接受了卡维地洛治疗。在失代偿期肝硬化患者中，310例（2.61%）接受了NSBB治疗，其中303例（2.55%）接受了普萘洛尔治疗，7例（0.06%）接受了卡维地洛治疗。有趣的是，七个地区在内镜治疗、介入治疗、NSBB治疗、脾切除术和其他手术治疗方面存在显著差异（<0.001）。目前，慢性乙型肝炎是我国几个地区肝硬化的主要病因（71.15%），酒精性肝病已成为我国肝硬化的第二大病因（11.27%）。我国应进一步加强肝硬化的三级防控。
