發(fā)布時間：2018-05-27 06:20

  本文選題：丙型肝炎病毒 + 慢性丙型肝炎��； 參考：《山西醫(yī)科大學》2017年碩士論文

【摘要】：目的:本研究旨在了解慢性丙型肝炎及丙型肝炎后肝硬化患者的人口學特征,行為生活方式、臨床特點等相關因素的暴露情況,用病例對照研究方法探討丙型肝炎后肝硬化的影響因素,為降低丙型肝炎后肝硬化的發(fā)生,提高患者的生活質量提供科學依據。方法:收集2010年6月-2016年6月于山西省晉城市第三人民醫(yī)院及山西省晉城市人民醫(yī)院明確診斷為慢性丙型肝炎及丙型肝炎后肝硬化住院患者共219例作為研究對象,對所有研究對象,依據2016年更新版《丙型肝炎防治指南》及患者臨床癥狀、體征、生化檢查、影像學檢查結果分為兩組,一組為病例組,由丙型肝炎后肝硬化患者組成,一組為對照組,由慢性丙型肝炎患者組成,兩組均采集患者身高、體重,并計算身體質量指數,空腹采取靜脈血檢測丙氨酸氨基轉移酶(ALT)、門冬氨酸氨基轉移酶(AST)、白蛋白(ALB)、總膽固醇(TC)、甘油三酯(TG)、空腹血糖(FBG)以及丙肝抗體(抗-HCV)、丙型肝炎病毒量(HCV-RNA)、丙型肝炎基因分型等。采用?2進行單因素分析,非條件logistic回歸進行多因素分析。相乘交互作用采用logistic回歸模型分析。相加交互作用采用Andersson等[33]編制的Excel軟件進行分析。結果:1.本次研究結果顯示:(1)研究對象中男女比例為1:1.46,女性占59.36%,男性占40.64%。(2)年齡大于等于60歲中丙型肝炎后肝硬化患者所占比例較高(52.94%),50~60歲及40~50歲中丙型肝炎后肝硬化患者所占比例分別為23.53%和22.35%,小于40歲的丙型肝炎后肝硬化患者所占比例較低,單因素分析差異有統(tǒng)計學意義(?2=32.390,P0.001)。(3)已婚的丙型肝炎后肝硬化患者所占比例為98.82%,高于未婚丙型肝炎后肝硬化患者(1.18%)。但無統(tǒng)計學意義(?2=2.421,P=0.121)。職業(yè)為農民和工人的丙型肝炎后肝硬化患者所占比例為71.76%,其他職業(yè)丙型肝炎后肝硬化患者所占比例為28.24%,差異無統(tǒng)計學意義(?2=0.51,P=0.473)。2.影響丙型肝炎后肝硬化的單因素分析顯示:吸煙、有肝病家族史、感染后有明顯臨床表現、合并HBV感染、糖尿病、高血壓,未接受抗病毒治療、AST≥40U/L、PTA80%、感染年限為1~3年者增加丙型肝炎后肝硬化的發(fā)病風險,差異有統(tǒng)計學意義(P0.05)。3.影響丙型肝炎后肝硬化的多因素分析顯示:控制性別、年齡、是否吸煙、是否有乙肝家族史、是否合并HBV感染、是否合并高血壓、PTA80%、丙型肝炎基因分型后,感染年限長(OR,OR95%CI:3.047,1.010~9.192;3.327,1.344~8.239)、感染后有明顯臨床表現(OR,OR95%CI:5.797,2.558~13.137)、合并糖尿病(OR,OR95%CI:7.169,2.182~23.557)、AST≥40U/L(OR,OR95%CI:3.242,1.496~7.024)、BMI≥28(OR,OR95%CI:2.663,1.160~6.114)是丙型肝炎后肝硬化的危險因素;接受抗病毒治療(OR,OR95%CI:0.370,0.165~0.833)是丙型肝炎后肝硬化的保護因素。4.交互作用結果顯示:各因素之間未發(fā)現有相乘和相加交互作用。結論:慢性丙型肝炎患者中,感染年限較長、感染后有明顯臨床表現、合并糖尿病、AST升高及肥胖者,會增加其發(fā)展為丙型肝炎后肝硬化的風險;而接受正規(guī)抗病毒治療者,可以降低丙型肝炎后肝硬化的發(fā)生風險。
[Abstract]:Objective: This study aims to understand the demographic characteristics, behavioral lifestyle, clinical characteristics and other related factors of chronic hepatitis C and HCV patients, and to explore the influencing factors of post hepatitis C cirrhosis by case control study, in order to reduce the incidence of HCV and improve the life of patients with hepatitis C. Methods: a total of 219 cases of hospitalized patients with chronic hepatitis C and hepatitis C were diagnosed in the third people's Hospital of Jincheng, Jincheng, Shanxi, and the people's Hospital of Jincheng, Shanxi Province, June 2010, in June -2016 years. The clinical symptoms, signs, biochemical tests, and imaging findings were divided into two groups. One group was a case group, composed of patients with hepatitis C and cirrhosis, a control group, a control group, a chronic hepatitis C patient, and two groups of patients who were measured in height, weight, and calculated body mass index, and vierine venous blood was used to detect alanine aminoamine. Transferase (ALT), aspartate aminotransferase (AST), albumin (ALB), total cholesterol (TC), triglyceride (TG), fasting blood glucose (FBG), hepatitis C antibody (anti -HCV), hepatitis C virus (HCV-RNA), hepatitis C gene typing, and so on. Use? 2 for single factor analysis and non conditional logistic regression for multifactor analysis. Multiplicative interaction The logistic regression model was used to analyze the addition of Excel software such as Andersson and other [33]. Results: 1. the results of the study showed: (1) the proportion of men and women in the study was 1:1.46, women accounted for 59.36%, and the male accounted for (2) age greater than 60 years of hepatitis C (52.94%), 50~6 The proportion of patients aged 0 and 40~50 was 23.53% and 22.35% respectively, and the proportion of patients less than 40 years old was lower. The difference in single factor analysis was statistically significant (? 2=32.390, P0.001). (3) the proportion of patients with hepatitis C after hepatitis C was 98.82%, higher than that of unmarried hepatitis C. Liver cirrhosis (1.18%). But there is no statistical significance (? 2=2.421, P=0.121). The proportion of patients with post hepatitis C cirrhosis in the occupation is 71.76%, the proportion of other occupational hepatitis C patients is 28.24%, the difference is not statistically significant (? 2= 0.51, P=0.473).2. affects the single factor analysis of hepatitis C cirrhosis It shows: smoking, family history of liver disease, obvious clinical manifestation after infection, combined with HBV infection, diabetes, hypertension, unreceived antiviral treatment, AST > 40U/L, PTA80%, 1~3 years of infection increase the risk of hepatitis C cirrhosis, the difference is statistically significant (P0.05).3. affects the multiple factors analysis of hepatitis C after hepatitis C Show: control sex, age, smoking, family history of hepatitis B, HBV infection, combined hypertension, PTA80%, hepatitis C genotyping, infection years (OR, OR95%CI:3.047,1.010~9.192; 3.327,1.344~8.239), after infection (OR, OR95%CI:5.797,2.558~13.137), combined with diabetes (OR, OR95%CI:7.169). 2.182~23.557), AST > 40U/L (OR, OR95%CI:3.242,1.496~7.024), BMI > 28 (OR, OR95%CI:2.663,1.160~6.114) is a risk factor for posthepatitic cirrhosis; the acceptance of antiviral therapy (OR, OR95%CI:0.370,0.165~0.833) is a protective factor for the protection factor of hepatitis C after hepatitis C, and the result shows that there is no multiplication and phase between the factors. Conclusion: in patients with chronic hepatitis C, there is a long period of infection and obvious clinical manifestation after infection. The combination of diabetes, elevated AST and obesity will increase the risk of the development of HCV after hepatitis C, and the risk of cirrhosis after hepatitis C can be reduced by regular antiviral therapy.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R512.63;R575.2

【參考文獻】

相關期刊論文 前10條

1 李楊;李愛華;龐琳;;醫(yī)院慢性丙型病毒性肝炎患者進展性肝纖維化的發(fā)生率及影響因素研究[J];中國艾滋病性病;2015年05期

2 廖柏明;甄秀梅;羅光漢;;丙型肝炎肝硬化患者預后相關危險因素分析[J];實用醫(yī)學雜志;2015年09期

3 許春;李佰君;顏迎春;張明香;魏倪;;慢性丙型肝炎病毒感染進展為肝硬化的危險因素分析[J];中華臨床感染病雜志;2015年02期

4 朱桂曉;邊城;;慢性丙型肝炎發(fā)展至肝硬化的臨床危險因素分析[J];中國社區(qū)醫(yī)師;2015年11期

5 Dorde Culafi;Milos tuli;Radmila Obrenovi;Danijela Mileti;Dragana Mija;Milica Stojkovi;Marija Jovanovi;Milica Culafi;;Role of cystatin C and renal resistive index in assessment of renal function in patients with liver cirrhosis[J];World Journal of Gastroenterology;2014年21期

6 Qing-Lei Zeng;Guo-Hua Feng;Ji-Yuan Zhang;Yan Chen;Bin Yang;Hui-Huang Huang;Xue-Xiu Zhang;Zheng Zhang;Fu-Sheng Wang;;Risk factors for liver-related mortality in chronic hepatitis C patients:A deceased case-living control study[J];World Journal of Gastroenterology;2014年18期

7 陳拉弟;;慢性丙型肝炎發(fā)展至肝硬化的影響因素分析[J];中國醫(yī)藥指南;2013年01期

8 卓蔡連;;生化酶譜檢測對原發(fā)性膽汁性肝硬化患者病情評估價值的探討[J];齊齊哈爾醫(yī)學院學報;2012年06期

9 劉紅虹;福軍亮;羅生強;施明;張紀元;王福生;;原發(fā)性膽汁性肝硬化預后的危險因素及機制研究進展[J];肝臟;2011年05期

10 邵鳴;肖玉珍;;乙肝40“一道坎”[J];肝博士;2010年06期

，

本文編號：1940809