215例急性和亚急性重型肝炎临床特征对比性分析

目的进一步了解急性重型和亚急性重型肝炎（简称急重和亚急重）患者的临床特征，以及它们之间的异同。方法收集和整理215例急重和亚急重住院患者的临床资料，使用X^2检验、t检验、回归分析等方法进行相关的统计学分析。结果①乙型肝炎病毒感染仍是急重和亚急重型肝炎的主要病因，均占30％以上。抗结核药物是药物性急重和亚急重肝炎的首要原因；②急重和亚急重患者肝性脑病发生率分别为78．13％和43．05％，差异有统计学意义（P〈0．001）；③急重患者的平均凝血酶原活动度低于20％，而亚急重患者平均凝血酶原活动度低于30％；④急重患者发生率前三位的并发症分别为肝性脑病、电解质紊乱及脑水肿；而亚急重则分别为腹水、电解质紊乱及肝性脑病；⑤急重和亚急重患者的病死率与病情最重时PT、WBC及中性粒细胞比例均呈正相关，而与PTA、TC均呈负相关；亚急重还与病情最重时TB、BLA及CRE呈正相关，与CHE、TG、PLT、ALB呈负相关。结论①急重和亚急重患者无论在好发年龄、肝性脑病发生率、肝性脑病出现时间，还是在凝血功能异常、预后与实验室指标等方面差异较大，属两个独立的疾病；②对于无肝性脑病的急重和亚急重患者，严重的凝血功能异常是一个重要的灵敏和特异性指标。

Comparative study on clinical features of 215 patients with acute and subacute severe hepatitides

Objective To analyze the clinical features of acute severe hepatitis (ASH) and subacute severe hepatitis (SSH) by comparison analysis.Methods The clinical features of 215 cases with ASH and SSH from 1995 to 2005 were retrospectively analyzed by using chi-test,t-test and regression analysis.Result The most common cause of ASH or SSH was hepatitis B virus(HBV) infection(>30%). Anti-tuberculosis therapy was the main cause of drug-induced ASH or SSH. The incidences of hepatic encephalopathy were 78.13% and 43.05% respectively (P<0.001). Prothrombin activity was less than 20% and less than 30%, respectively in cases with ASH and SSH. The most common complications of ASH were hepatic encephalopathy, imbalance of electrolyte and cerebral edema, and that of SSH were ascites, imbalance of electrolyte and hepatic encephalopathy. Prothrombin time, ratio of WBC and neutrophil count were positively related to case-fatality of ASH or SSH. Prothrombin activity and total cholesterol (TC) were negatively correlated with fatality of ASH or SSH. Total bilirubin, blood ammonia and creatinine were also positively correlated with fatality of SSH; chlolinesterase, triglyceride, PLT, albumin were negatively correlated with fatality of SSH.Conclusions ASH and SSH are two different entities because of obvious differences in the ages of suffering, the incidence and occurring time of hepatic encephalopathy, abnormality of function of blood coagulation and the marker for predicting prognosis. Severe abnormality of function of blood coagulation is an important marker with high sensitivity and specificity in ASH or SSH patients without hepatic encephalopathy.