【摘要】 [目的]探讨影响慢性乙型肝炎反复发作的因素,指导预防慢性乙型肝炎患者的发作和临床治疗。[方法]采用病例对照研究,严格按照病例和对照的纳入和排除标准,随机抽取2006年6月到2007年5月在唐山市传染病院收住院的两次以上的慢性乙型肝炎患者194例组成病例组;选择发病1次的慢性乙型肝炎患者为对照。采用面对面问卷方式填写调查表。以聚合酶链反应定量分析HBVDNA;进行肝组织病理及免疫组化检查。[结果]单因素非条件Logistic回归分析显示:影响慢性乙型肝炎反复发作有显著性统计学意义的14个变量如下:12个危险因素:从事体力劳动(OR=4.091,95%CI:2.397～6.982);慢性乙型肝炎病史(OR=2.801,95%CI:1.271～6.173);重叠HEV病毒感染(OR=4.153,95%CI:2.297～7.510);父亲患有乙型肝炎史(OR=9.152,95%CI:2.611～31.474);母亲患有乙型肝炎史(OR=3.924,95%CI:2.154～7.150);既往有手术史(OR=5.429,95%CI:1.959～15.045);饮酒史(OR=2.198,95%CI:1.605～3.011);甜食摄入(OR=1.725,95%CI:1.196～2.488);血型(OR=2.283,95%CI:1.328～3.925);PCR-HB-VDNA定量(OR=2.313,95%CI:1.523～3.514);肝组织炎症程度G(OR=1.438,95%CI:1.156～1.788);肝组织免疫组化HBcAg阳性(OR=2.264,95%CI:1.410～3.637);2个保护因素:使用抗病毒药物(OR=0.238,95%CI:0.136～0.416);文化程度(OR=0.545,95%CI:0.423～0.704)。[结论]从事体力劳动、慢性乙型肝炎病史、父、母患有乙型肝炎、手术史、饮酒史、甜食摄入、重叠HEV病毒感染、高PCR-HBVDNA定量和肝组织炎症程度(G)高是影响慢性乙型肝炎反复发作的重要危险因素;使用抗病毒药物是保护性因素。更多还原

【Abstract】 [Objective] To explore the factors of affecting the recurrence of chronic hepatitis B,and to instruct the clinical treatment for the recurrence of chronic hepatitis B.Methods 194 patients with case history of two times recurrence of chronic hepatitis B in Tangshan infectious disease hospital from August 2004 to October 2005 were randomly collected in line with the including and excluding criteria by case-control study.Patients with one time occurrence of chronic hepatitis B were recruited as controls.Face to face investigation was conducted.The quantitative analysis was performed to analyze HBVDNA.The pathological and immunohistochemical methods were used to examine liver tissue.Results By single factor logistic regression analysis,14 factors impacted on the recurrence of chronic hepatitis B including 12 risk factors and 2 protective factors as follows:occupation in manual labor(OR = 4.091,95%CI:2.397-6.982),chronic hepatitis B disease history(OR = 2.801,95%CI:1.271-6.173),suffering from otherdiseaseat the same time(OR = 4.153,95%CI:2.297-7.510),hepatitis B history of father(OR = 9.152,95%CI:2.611-31.474),hepatitis B history of mother(OR = 3.924,95%CI:2.154-7.150),surgical history(OR = 5.429,95%CI:1.959-15.045),alcohol drinking history(OR = 2.198,95%CI:1.605-3.011),sweetmeat intake(OR = 1.725,95%CI:.196-2.488),blood type(OR = 2.283,95%CI:1.328-3.925),PCR-HBVDNA quantitation(OR = 2.313,95%CI:1.523-3.514),degree G of liver organization(OR = 1.438,95%CI:1.156-1.788),positive HBcAg(OR = 2.264,95%CI:1.410-3.637),utilization of anti-virus drug(OR = 0.238,95%CI:0.136-0.416)and education level(OR = 0.545,95%CI:0.423-0.704).Conclusion This study shows that occupation in manual labor,the chronic hepatitis B history,parents who have Hepatitis B history,surgical operation history,the alcohol history,sweetmeat intake,suffering from other disease at the same time,the PCR-HBVDNA quantitation as well as inflammation degree of liver tissue are the main factors that influence the recurrence of chronic hepatitis B,while utilization of anti-virus drug is the protective factors.更多还原