202例老年重型肝炎病因学及预后分析

目的探讨老年重型肝炎病因学及预后的相关特点。方法将本院10年来诊治的202例老年重型肝炎患者与同期2138例中青年重型肝炎患者作对照,比较两个年龄组急性重型肝炎（ALF）、亚急性重型肝炎（SLF）、慢性重型肝炎（CLF）的患病率、病因学及转归情况。结果两个年龄组重型肝炎均以CLF为主（老年组63.3%,中青年组83.7%）,而老年组中SLF所占的比率（30.6%）显著高于中青年组（12.6%）。导致老年重型肝炎的前3位病因依次为：乙型肝炎（56.4%）、戊型肝炎（19.8%）、未分型肝炎（10.9%）;两组重型肝炎患者治疗无效病例老年组为63.9%,中青年组为52.4%,差异具有统计学意义（P〈0.05）,且重型肝炎老年组中SLF和CLF治疗无效病例显著高于中青年组;导致重型肝炎老年组预后不佳的前3位病因依次为：乙型肝炎（65.1%）、戊型肝炎（13.2%）、未分型肝炎（7.0%）;因戊型或乙型肝炎病毒感染发展至重型肝炎的老年患者治疗无效病例分别为44.7%和73.7%,显著高于中青年组的24.5%和54.8%（P〈0.05）。结论老年重型肝炎以CLF为主,病因主要为乙型肝炎、戊型肝炎、未分型肝炎;老年重型肝炎多预后不良,且导致治疗无效的病因主要为乙型肝炎、戊型肝炎和未分型肝炎。老年患者在戊型和乙型肝炎病毒感染后应警惕重型肝炎的发生。

Etiology and prognosis analysis on 202 cases of elderly patients with severe liver diseases

Objective To investigate the etiology and prognosis of elderly patients with severe liver diseases.Methods The etiology and prognosis of severe liver diseases in patients aged 60 or above（n= 202）and patients under 60 years old（n= 2138）from 2000 to 2010 were compared.Results Chronic liver failure was the main reason in patients of this study,subacute liver failure in elderly patients（30.6%）were significantly more than young and middle-aged patients（12.6%）.Poor prognosis in elderly patients were owing to HBV（65.1%）,HEV（13.2%）and untyped hepatitis（7.0%）.Treatment futility in elderly patients with liver failure caused by HEV（44.7%）and HBV（73.7%）were significantly more than young and middle-aged group（24.5% and 54.8%）（P〈0.05）.Conclusions Most elderly patients were complicated by chronic liver failure,HBV and HEV infection were significantly much more prevalent in the elderly.However,causes of poor prognosis in elderly patients with liver failure were due to HBV,HEV and untyped hepatitis.Thus,the etiology and the prognostic factors of liver failure in elderly patients were different from those in younger patients.