肝硬化病原学分析和乙肝肝硬化中HBeAg阳性与阴性患者的临床特点比较

目的 通过大样本横断面回顾性调查，了解临床肝硬化患者病原组成及临床所见HBeAg(－)和HBeAg(＋)两类肝硬化患者临床相关因素的异同。 方法 对599例肝硬化患者的住院病历进行回顾性调查，分析肝硬化患者病因构成及占主要病因的乙肝肝硬化中的HBeAg(－)和HBeAg(＋)肝硬化组年龄、ALT、HBV DNA定量、CTP评分、PLT等指标的组内和组间差异。 结果 在肝硬化病因中以病毒性肝炎后肝硬化常见，有557例，占93.0％，其中又以乙肝肝硬化居多。在乙肝肝硬化中HBeAg (－)乙肝肝硬化306例，占62.3％；HBeAg(＋)肝硬化185例，占37.7％。HBeAg(＋)组ALT、HBV DNA总体上均高于HBeAg(－)组。HBeAg(－)组患者年龄明显高于HBeAg(＋)组。两组之间Child-Pugh，（CTP）积分无明显差异。 结论 目前我国临床所见肝硬化病例以病毒性肝炎感染后所致占绝大多数，乙肝肝硬化中又以HBeAg(－)者占多数。HBeAg(－) 与HBeAg(＋)肝硬化患者在病情轻重方面无明显差异，无论HBeAg是否阳性，病毒载量高时，抗病毒治疗及控制肝脏炎症能减轻病情恶化。

Etiological analysis of liver cirrhosis and Comparison of clinical characteristics between HBeAg-negative and HBeAg-positive patients with liver cirrhosis

Objective To analyze the causes of liver cirrhosis and investigate the clinical characteristics of HBeAg-negative and HBeAg-positive patients with liver cirrhosis through a cross-sectional retrospective analysis.Methods The data on 599 patients with liver cirrhosis were retrospectively analyzed to investigate the etiology of liver cirrhosis. Serum ALT levels, quantitative HBV DNA, PLT levels, ages, and CTP score were analyzed and compared between HBeAg-negative and HBeAg-positive patients. Results 557 of 599 (92.99%) cases of cirrhosis were induced by viral hepatitis and most infected with HBV. HBeAg was negative in 306 (62.3%) patients with cirrhosis and positive in the remaining 185 (37.7%). Patients with HBeAg-negative were markedly older but had lower serum ALT and HBV DNA levels than those with HBeAg-positive. There was no significant difference in CTP score between HBeAg-negative and HBeAg-positive patients. Conclusions The great majority of liver cirrhosis in our nation are induced by viral hepatitis,especially HBeAg-negative hepatitis B. Patients with HBeAg-negative cirrhosis are similar to those with HBeAg-positive in the severity of the disease. Antiviral therapy and control of hepatic inflammation can relieve deterioration of cirrhosis no matter the patient is HBeAg-positive or not but has a high virus load.