【摘要】 目的探讨临床诊断巨脾型晚期日本血吸虫病(晚血)患者的远期预后及影响远期预后的危险因素。方法对153例临床诊断为巨脾型晚血患者做病理检查,并进行5~14年(平均随访10年)的远期随访观察。分析影响远期预后的危险因素。用SPSS11.0软件进行单因素条件和多因素逐步条件Logistic回归分析。结果153例临床诊断为巨脾型晚血患者做肝组织病理检查,属单纯血吸虫性肝纤维化92例(60.13%),血吸虫性肝纤维化合并肝炎(伴肝细胞变性、坏死)32例(20.92%),肝炎肝硬化15例(9.80%),慢性肝炎7例(4.58%),其他疾病7例(4.58%)。随访5~14年(平均随访10年),死亡45例,肝炎肝硬化及血吸虫肝纤维化伴肝细胞病变者病死率均显著高于单纯血吸虫肝纤维化患者(P<0.05),多数患者死于肝衰竭及原发性肝癌。死者生前均存在HBV和/或HCV感染。单因素条件Logistic分析表明,男性、年龄>50岁、有腹水、血清白蛋白降低、HBsAg阳性和乙肝病毒复制为晚血死亡的危险因素。多因素逐步条件Logistic回归分析表明,HBsAg阳性、乙肝病毒复制、年龄>50岁、血清白蛋白降低和腹水为晚血死亡的危险因素。结论HBV感染是晚血发生肝衰竭及肝癌的关键因素,与患者死亡密切相关。乙肝病毒的感染及复制、年龄>50岁、血清白蛋白降低及腹水均可增加巨脾型晚血患者死亡的危险性。更多还原

【Abstract】 Objective To investigate long-term prognosis and risk factors on patients with clinical diagnosis of splenomegalic advanced schistosomiasis japonica(AS).Methods Liver biopsy was done on 153 patients with clinical diagnosis of AS.The clinical outcome of the patients was followed up for 5 to 14 years(mean 10 years).The risk factors affecting the long-term prognosis of patients with AS were analyzed.Statistical analysis was performed by single factor and stepwise conditional logistic regression analysis with SPSS 11.0 software.Results According to the histological findings,92 out of 153 patients(60.13%) were diagnosed as schistosomiasis with liver fibrosis(SLF),32(20.92%) were SLF accompanied chronic hepatitis,15(9.80%) were hepatitis-cirrhosis,7(4.58%) were chronic hepatitis and 7(4.58%) were other diseases.Among 153 patients being followed up,45 patients died.The mortality of the patients with SLF(20.65%) was lower than that of patients with SLF accompanied with chronic hepatitis(40.63%) and patients with hepatitis-cirrhosis(66.67%,P< 0.05).The most common cause of death was hepatic failure(21 cases) and the second cause was hepatocellular carcinoma(9 cases).Most of these patients were positive for HBV markers.By single factor conditional logistic regression analysis,it was revealed that HBsAg-positive,HBV replication,male,age more than 50 years,hypoalbuminemia,ascites were risk factors for death of patient with AS.By stepwise conditional logistic regression analysis,it was revealed that HBsAg-positive,HBV replication,age more than 50 years,hypoalbuminemia,ascites were risk factors for death of patient with AS.Conclusion The death of patients with AS is associated with hepatitis B,elder age,hypoalbuminemia,ascites.HBV infection may play a crucial role in occurrence of hepatic failure,hepatocellular carcinoma and death of patients with AS.更多还原