急性乙型肝炎与慢性乙型肝炎急性发作的临床特征比较

李强; 卓其斌; 黄玉仙; 陈良

doi:10.3969/j.issn.1001-5256.2016.04.019

急性乙型肝炎与慢性乙型肝炎急性发作的临床特征比较

DOI: 10.3969/j.issn.1001-5256.2016.04.019

复旦大学附属公共卫生临床中心肝炎一科

基金项目:

上海市科委“科技创新行动计划”医学与农业领域重点项目(13401902100)；市级医院新兴前沿技术联合攻关项目(SHDC12015129)；

详细信息

中图分类号: R512.62
计量
- 文章访问数: 2687
- HTML全文浏览量: 24
- PDF下载量: 436
- 被引次数: 0
出版历程
- 出版日期: 2016-04-20

Clinical features of acute hepatitis B and acute exacerbation of chronic hepatitis B: a comparative study

First Department of Hepatitis, Public Health Clinical Center Affiliated to Fudan University

Research funding:

摘要

摘要:
目的探讨鉴别急性乙型肝炎（AHB）和慢性乙型肝炎（CHB）急性发作的临床特征。方法回顾性分析2014年6月-12月在复旦大学附属公共卫生临床中心就诊的96例AHB和124例CHB急性发作患者的临床资料。计量资料组间比较采用MannWhitney U检验,计数资料组间比较采用χ2检验。结果 AHB和CHB急性发作在发病年龄和性别方面差异无统计学意义,男性发病率高于女性。AHB以性接触和医源性传播为主,而CHB急性发作以母婴垂直传播为主。基线ALT水平≥1072 U/L诊断AHB的敏感性和特异性分别为78.6%和79.2%;抗-HBc-Ig M滴度≥13.6 S/CO诊断AHB的敏感性和特异性分别为94.5%和89.3%。入院2周时AHB组HBs Ag、HBe Ag和HBV DNA较基线的下降值均显著高于CHB急性发作组且差异有统计学意义（P值均<0.05）。入院第8周时AHB患者HBs Ag阴转率、抗-HBs阳转率、HBe Ag阴转率、抗-HBe阳转率和HBV DNA阴转率均显著高于CHB急性发作患者（P值均<0.05）。结论明确传...
- 肝炎,乙型,慢性 /
- 急性乙型肝炎 /
- 对比研究
Abstract:
Objective To investigate the clinical features of acute hepatitis B( AHB) and acute exacerbation of chronic hepatitis B( CHB)for differential diagnosis. Methods A retrospective analysis was performed on the clinical data of 96 AHB patients and 124 patients with acute exacerbation of CHB,who were admitted to the Public Health Clinical Center Affiliated to Fudan University from June to December,2014. Comparison of continuous data between the two groups was made by Mann Whitney U test,while comparison of categorical data was made by chi- square test. Results There were no significant differences in the age of onset and sex between the AHB group and the acute exacerbation of CHB group; the incidence was higher in males than in females. Sexual transmission and iatrogenic transmission were the main routes of transmission for AHB,while mother- to- child transmission was the main route of transmission for acute exacerbation of CHB. The sensitivity and specificity of alanine aminotransferase( ALT) level ≥1072 U / L for diagnosing AHB were 78. 6% and 79. 2%,respectively. The sensitivity and specificity of S / CO ≥13. 6 in the anti- HBc- Ig M test for diagnosing AHB were 94. 5% and 89. 3%,respectively. At week 2 after admission,the AHB group showed significantly greater decreases in levels of HBs Ag,HBe Ag,and hepatitis B virus( HBV) DNA than the acute exacerbation of CHB group( P < 0. 05). At week 8 after admission,the AHB group had significantly higher HBs Ag clearance rate,anti- HBs seroconversion rate,HBe Ag clearance rate,anti- HBe seroconversion rate,and HBV DNA clearance rate than the acute exacerbation of CHB group( P < 0. 05). Conclusion It is helpful for making the differential diagnosis between AHB and acute exacerbation of CHB to know the route of transmission,ALT level,anti- HBc- Ig M test result( S / CO value),HBV DNA clearance rate,and the seroconversion rates of HBV markers.
- hepatitis B,chronic /
- acute hepatitis B /
- comparative study

HTML全文

参考文献(12)

[1]HU XL,ZHAO HW,WU XY,et al.Prevalence of hepatitis B virus infection[J].J Clin Hepatol,2012,28(6):413-416.(in Chinese)胡晓丽,赵宏伟,吴晓岩,等.乙型肝炎病毒感染的流行现状[J].临床肝胆病杂志,2012,28(6):413-416.

[2]SHIFFMAN ML.Management of acute hepatitis B[J].Clin Liver Dis,2010,14(1):75-91.

[3]JINDAL A,KUMAR M,SARIN SK.Management of acute hepatitis Band reactivation of hepatitis B[J].Liver Int,2013,33(Suppl 1):164-175.

[4]Chinese Society of Infectious Diseases and Parasitology,Chinese Society of Hepatology,Chinese Medical Association.Prevention and treatment of viral hepatitis[J].Chin J Hepatol,2000,8(6):324-329.(in Chinese)中华医学会传染病与寄生虫病学分会,肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志,2000,8(6):324-329.

[5]Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B(2010 version)[J].J Clin Hepatol,2011,27(1):Ⅰ-ⅩⅥ.(in Chinese)中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2010年版)[J].临床肝胆病杂志,2011,27(1):Ⅰ-ⅩⅥ.

[6]CUI FQ,WANG FZ,ZHENG H,et al.Analysis on reported cases of hepatitis B in China in 2005-2007[J].Chin J Vaccines Immunization,2008,14(5):413-417.(in Chinese)崔富强,王富珍,郑徽,等.中国2005~2007年乙型病毒性肝炎发病分析[J].中国疫苗和免疫,2008,14(5):413-417.

[7]KUNIHOLM MH,PURCELL RH,MCQUILLAN GM,et al.Epidemiology of hepatitis E virus in the United States:results from the Third National Health and Nutrition Examination Survey,1988-1994[J].J Infect Dis,2009,200(1):48-56.

[8]WU WS,ZHAO Y,CHEN J,et al.Incidence trend of acute hepatitis B and related risk factors in Tianjin[J].Dis Surveill,2014,29(9):729-732.(in Chinese)吴伟慎,赵莹,陈静,等.天津市急性乙型病毒性肝炎流行特征及感染危险因素研究[J].疾病监测,2014,29(9):729-732.

[9]HUANG LF,ZHOU Y,ZHENG JF,et al.Analysis on acute hepatitis B surveillance in Fujian in 2013[J].Strait J Prevent Med,2014,20(5):11-12.(in Chinese)黄丽芳,周勇,郑金凤,等.福建省2013年急性乙型肝炎监测分析[J].海峡预防医学杂志,2014,20(5):11-12.

[10]HE CL,SUI YH,GAO L,et al.Analysis of the clinical characteristic of 176 patients with acute hepatitis B[J].J Pract Hepatol,2006,9(4):217-218.(in Chinese)何长伦,隋云华,高蕾,等.176例急性乙型肝炎临床特点分析[J].实用肝脏病杂志,2006,9(4):217-218.

[11]ZHANG ZQ,DONG HJ,HUANG SP,et al.The value of differential diagnosis of alanine transaminase and aspartate aminotransferase between acute hepatitis B and chronic hepatitis B[J].J Pract Hepatol,2005,8(1):34-35.(in Chinese)张占卿,董华娟,黄绍萍,等.血清丙氨酸氨基转移酶和门冬氨酸氨基转移酶对急性与慢性乙型肝炎的鉴别意义[J].实用肝脏病杂志,2005,8(1):34-35.

[12]LI Y,XIAO L,YANG XZ,et al.The serology differential diagnosis between acute hepatitis B and acute exacerbation of chronic hepatitis B[J].Chin Hepatol,2012,17(4):292-293.(in Chinese)李阳,肖丽,杨秀珍,等.急性乙型肝炎和慢性乙型肝炎急性发作的血清学鉴别[J].肝脏,2012,17(4):292-293.

施引文献

资源附件(0)

访问统计