南通地区近5年重症戊型肝炎的危险因素和临床特征分析
| 作 者：杨玲美, 沈金平, 陈琳, 钱湘云, 薛红, 王洁, 邵建国 |
| 单 位：南通市第三人民医院 |
| 基金项目：南通市科技项目 |
| 摘 要： |
| 背景：戊型肝炎（HE）是由戊型肝炎病毒（HEV）感染引起的急性病毒性肝炎，全球每年约有2 000万例新发感染。近年来，我国HE的发病率呈持续上升趋势。目的：探讨南通地区近5年重症HE的危险因素和临床特征。方法：回顾性分析2019年4月—2024年5月南通大学附属南通第三医院收治的605例HE患者，其中54例为重症HE，包括14例HE+慢性乙型肝炎（CHB）和40例单纯HE。采用多因素Logistic回归分析筛选重症HE的独立危险因素。比较重症HE+CHB与单纯重症HE患者的临床资料、实验室指标。根据入院前是否规律接受抗病毒治疗，HE+CHB患者进一步分为抗病毒组和未抗病毒组，比较两组患者的实验室指标。结果：年龄、合并CHB、载脂蛋白A（ApoA）、CD4+/CD8+ T细胞比值、白细胞介素-6（IL-6）和Ⅳ型胶原是重症HE的独立危险因素（P均<0.05）。与单纯重症HE组相比，重症HE+CHB组的腹水发生率、总胆红素（TBil）、IgG、类风湿因子（RF）、Ⅳ型胶原水平显著升高（P均<0.05），血小板计数、T细胞、CD8+ T细胞水平显著降低（P均<0.05）。接受抗病毒治疗的重症HE+CHB患者的TBil、IgG、RF、Ⅳ型胶原水平显著高于未接受抗病毒治疗者（P均<0.05），血小板计数、T细胞、CD8+ T细胞、HBV DNA水平显著降低（P均<0.05）。结论：重症HE的危险因素为年龄、合并CHB、ApoA、CD4+/CD8+ T细胞比值、IL-6和Ⅳ型胶原。与单纯重症HE患者相比，重症HE+CHB患者的病情更重、肝纤维化程度更高。抗病毒治疗对重叠感染者具有一定的病毒抑制效果。早期识别和干预这些危险因素有助于改善HE患者的预后。 |
| 关键词：戊型肝炎；慢性乙型肝炎；重叠感染；危险因素 |
Analysis of Risk Factors and Clinical Characteristics of Severe Hepatitis E in Nantong Area Over the Past Five Years
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| Abstract: |
| Background: Hepatitis E (HE) is an acute viral hepatitis caused by hepatitis E virus (HEV) infection, with approximately 20 million new infections worldwide each year. The incidence of HE in China has shown a continuous upward trend in recent years. Aims: To explore the risk factors and clinical characteristics of severe HE in Nantong area over the past five years. Methods: A retrospective analysis was performed on 605 patients with HE admitted to the Third Affiliated Hospital of Nantong University from April 2019 to May 2024. Among them, 54 cases were severe patients, including 14 cases of HE combined with chronic hepatitis B (CHB) and 40 cases of HEV mono-infection. Multivariate Logistic regression analysis was used to screen independent risk factors for severe HE. Clinical data and laboratory indicators were compared between severe HE+ CHB and severe HEV mono-infection patients. According to regular use of antiviral therapy before admission or not, patients with HE + CHB were further divided into antiviral group and non‑antiviral group, and their laboratory parameters were compared. Results: Age, comorbid CHB, apolipoprotein A (ApoA), CD4+/CD8+ T cells ratio, interleukin‑6 (IL‑6) and type Ⅳ collagen were independent risk factors for severe HE (all P<0.05). Compared with the severe HEV mono-infection group, the severe HE+CHB group had a significantly higher incidence of ascites, as well as higher levels of total bilirubin (TBil), IgG, rheumatoid factor (RF) and type Ⅳ collagen (all P<0.05), while platelet count, T cells and CD8+ T cells levels were significantly decreased (all P<0.05). In patients with severe HE+CHB who received antiviral therapy, the levels of TBil, IgG, RF and type Ⅳ collagen were significantly higher than those in non-antiviral patients (all P<0.05), whereas platelet count, T cells, CD8+ T cells and HBV DNA levels were markedly decreased (all P<0.05). Conclusions: The risk factors for severe HE include age, comorbid CHB, ApoA, CD4+/CD8+ T cells ratio, IL-6, and type Ⅳ collagen. Compared with patients with severe HEV mono-infection, patients with severe HE+CHB had more severe disease and a higher degree of liver fibrosis. Antiviral therapy exerted a certain viral suppressive effect in patients with superinfection. Early identification and intervention of these risk factors may help improve the prognosis of patients with HE. |
| Keywords: Hepatitis E; Chronic Hepatitis B; Overlapping Infection; Risk Factors |
| 投稿时间：2025-07-17 |
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