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中华实验和临床感染病杂志(电子版) ›› 2017, Vol. 11 ›› Issue (05) : 490 -495. doi: 10.3877/cma.j.issn.1674-1358.2017.05.013

临床论著

21 819例老年住院肝病患者病因及死亡原因分析
张亦瑾1, 万钢2, 高学松1, 李洪杰1, 刘丽改1, 刘楠1, 欧蔚妮3, 段雪飞1,()   
  1. 1. 100015 北京,首都医科大学附属北京地坛医院综合科
    2. 100015 北京,首都医科大学附属北京地坛医院病案室
    3. 100015 北京,首都医科大学附属北京地坛医院肝病三科
  • 收稿日期:2016-11-28 出版日期:2017-10-15
  • 通信作者: 段雪飞
  • 基金资助:
    北京市卫生系统高层次卫生技术人才队伍建设专项经费资助项目(No. 2014-3-093); 首都卫生发展科研专项项目(No. 2014-2-2172)

Etiology and causes of death in elderly patients with liver diseases

Yijin Zhang1, Gang Wan2, Xuesong Gao1, Hongjie Li1, Ligai Liu1, Nan Liu1, Weini Ou3, Xuefei Duan1,()   

  1. 1. Department of General Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
    2. Medical Records Department, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
    3. The 3rd Division of Liver Disease, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2016-11-28 Published:2017-10-15
  • Corresponding author: Xuefei Duan
引用本文:

张亦瑾, 万钢, 高学松, 李洪杰, 刘丽改, 刘楠, 欧蔚妮, 段雪飞. 21 819例老年住院肝病患者病因及死亡原因分析[J/OL]. 中华实验和临床感染病杂志(电子版), 2017, 11(05): 490-495.

Yijin Zhang, Gang Wan, Xuesong Gao, Hongjie Li, Ligai Liu, Nan Liu, Weini Ou, Xuefei Duan. Etiology and causes of death in elderly patients with liver diseases[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2017, 11(05): 490-495.

目的

研究老年肝病患者的病因及死亡的相关危险因素。

方法

选取首都医科大学附属北京地坛医院2008年9月至2016年3月老年肝病住院患者21 819例,按时间段分为两组,第一组为2008年9月至2011年12月收治的5 762例患者和第二组为2012年1月至2016年3月收治的16 057例患者,回顾性分析相关资料。

结果

老年肝病患者以60~65岁年龄组患者最多,且男性患者多于女性患者。两组老年肝病患者病因仍以病毒性肝炎为主,但所占比例呈下降趋势(χ2 = 45.78、P < 0.001),非酒精性脂肪性肝病的发病数占老年肝病的比例呈上升趋势(χ2 = 117.19、P < 0.001)。第二组老年肝病住院患者住院病死率(3.98%)低于第一组的住院病死率(5.74%),差异具有统计学意义(χ2 = 26.16、P < 0.001)。两组老年肝病患者的主要死亡原因均为原发性肝癌,差异无统计学意义。第一组与第二组患者死因构成中,肝功能衰竭病死率由8.16%上升至17.06%(χ2 = 14.33、P < 0.001);而肝硬化病死率由26.28%降至15.34%(χ2 = 16.93、P < 0.001),差异均具有统计学意义。死亡患者并发症中自发性细菌性腹膜炎的发生率由86.21%降至56.12%,差异具有统计学意义(χ2 = 19.97、P < 0.001)。上消化道出血和肝性脑病的发生率有所升高,但差异均无统计学意义。回归分析结果显示,肝癌、肝功能衰竭、肝硬化、上消化道出血、肝性脑病、肝肾综合征、自发性细菌性腹膜炎和腹水均是患者死亡的显著危险因素。

结论

病毒性肝炎仍是老年肝病的主要病因,但所占比例有下降趋势,而非酒精性脂肪性肝病呈上升趋势。老年肝病患者病死率有所下降,原发性肝癌是老年肝病死亡的主要原因。

Objcetive

To analyze the etiology and the causes of death of elderly patients with liver diseases.

Methods

Total of 21 819 elderly patients with liver diseases hospitalized in Beijing Ditan Hospital, Capital Medical University, were divided into two groups. The data of 5 762 patients collected from September 2008 to December 2011 and 16 057 patients collected from January 2012 to March 2016, were reviewed, retrospectively.

Results

Elderly patients with liver diseases in the 60-65 years old group were the most, more male than femal. Viral hepatitis was still the main cause of liver diseases of elderly patients in different period, but the proportion showed a downward trend (χ2 = 45.78, P < 0.001). The incidence of nonalcoholic fatty liver disease accounted for the proportion of elderly liver diseases increased (χ2 = 117.19, P < 0.001). The fatality rate (3.98%) of elderly patients with liver diseases from 2012 to 2016 was lower than that of the mortality from 2008 to 2011 (5.74%), with significant differences (χ2 = 26.16, P < 0.001). The main causes of death in the aged patients with liver diseases in different periods were primary hepatocellular carcinoma, there was no significant difference. The mortality rate of liver failure increased from 8.16% to 17.06% (χ2 = 14.33, P < 0.001), while the mortality rate of liver cirrhosis decreased from 26.28% to 15.34%, with significant difference (χ2 = 16.93, P < 0.001). The incidence of spontaneous bacterial peritonitis in patients with death was significantly decreased from 86.21% to 56.12%, with significant difference (χ2 = 19.97, P < 0.001). Regression analysis results showed that the liver cancer, liver failure, liver cirrhosis, upper gastrointestinal bleeding, hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis and ascites were all significant risk factors for death.

Conclusions

The incidence of viral hepatitis had a downward trend, but was still the main cause of elderly patients in liver disease. The incidence of nonalcoholic fatty liver disease was on the rise. The mortality of elderly patients with liver diseases decreased. HCC was the main cause of death in elderly patients with liver diseases.

表1 不同时间段不同年龄组患者性别构成[例(%)]
表2 不同时间段不同年龄组患者的构成[例(%)]
表3 不同时间段老年肝病病因构成[例(%)]
表4 不同时间段老年肝病患者的死因构成(%)
表5 不同时期老年肝病患者死亡的病因风险
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