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目的进一步了解急性重型肝炎患者的临床特征。方法回顾性分析64例急性重型肝炎患者的临床资料。结果患者好发年龄段为16～40岁;乙型肝炎病毒感染占34.4%,其次为戊型肝炎病毒感染和病原未明者,均分别约占20%以上。在药物性急性重型肝炎患者中,抗结核药物占首位;肝性脑病的发生率为78.1%,出现肝性脑病的时间为1～30天(9.92±6.52天),肝性脑病的程度与病死率呈正相关(P<0.001);无论在发生肝性脑病时,或在诊断重型肝炎时或在病情最重时,平均凝血酶原时间均在50秒以上,凝血酶原活动度均低于20%;患者腹水发生率为46.9%;患者的病死率与病情最重时PT、WBC及中性粒细胞比例呈正相关,而与PTA、TC呈负相关;患者前三位的并发症分别为肝性脑病、电解质紊乱及脑水肿,而与死亡有关的前三位并发症分别为脑疝、肝肾综合征及脑水肿。结论急性重型肝炎患者的病因正呈多元化倾向,病死率高,治疗困难。
Objective To further understand the clinical features of patients with acute severe hepatitis. Methods The clinical data of 64 patients with acute severe hepatitis were retrospectively analyzed. Results The prevalence of patients was 16-40 years old. The incidence of hepatitis B virus infection was 34.4%, followed by that of hepatitis E virus infection and the unknown pathogen, accounting for about 20% respectively. In drug-induced acute severe hepatitis patients, anti-TB drugs accounted for the first place; the incidence of hepatic encephalopathy was 78.1%, hepatic encephalopathy time was 1-30 days (9.92 ± 6.52 days), the degree of hepatic encephalopathy and death (P <0.001). The average prothrombin time was above 50 seconds in either hepatic encephalopathy, severe hepatitis or severe condition, and the activity of prothrombin was less than 20 %; The incidence of ascites in patients was 46.9%; the mortality of patients was positively correlated with the proportion of PT, WBC and neutrophils in the most serious condition, but negatively correlated with PTA and TC; the complications of the top three patients were liver Encephalopathy, electrolyte imbalance and cerebral edema, while the top three complications related to death were hernia, hepatorenal syndrome and cerebral edema. Conclusion The causes of acute severe hepatitis are diversified, with high mortality rate and difficult treatment.