CAJ | 학술논문

目的：了解急性乙型肝炎（乙肝）合并胆汁淤积性肝病的临床特点和危险因素。方法收集2008年6月至2014年4月的急性和慢性乙肝病例（115和263例），比较两组合并胆汁淤积性肝病的发生率，再将急性乙肝分为淤胆组23例和非淤胆组92例，比较两组年龄、性别、有无长期大量饮酒、住院天数、血常规、肝功能、HBV 血清学标志物、HBV DNA等，将有差异的指标做二元 Logistic 回归分析。结果急性和慢性乙肝合并胆汁淤积性肝病的比例分别为20.00％和1.14％（P ＝0.000）。急性乙肝淤胆组患者的年龄（48.87±7.63）岁、住院天数（34.6±11.3）d、外周血单核细胞比例16.34（8.1～30.00）％、HBeAg 效价34.30（0.37～1442.24）S／CO、HBV DNA 定量6.46×105（1.21×102 ～ 1.25×107）拷贝／mL，AST／ALT 0.51±0.20均高于非淤胆组（P ＜0.05）；患者年龄、外周血单核细胞比例和 HBV DNA 水平是急性乙肝合并胆汁淤积性肝病的危险因素（OR 值分别为 1.09、1.16、3.24，P ＜0.05）。结论急性乙肝合并胆汁淤积性肝病的发生率较慢性乙肝高；患者年龄、外周血单核细胞比例和 HBV DNA 水平是急性乙肝合并胆汁淤积性肝病的危险因素。
목적：료해급성을형간염（을간）합병담즙어적성간병적림상특점화위험인소。방법수집2008년6월지2014년4월적급성화만성을간병례（115화263례），비교량조합병담즙어적성간병적발생솔，재장급성을간분위어담조23례화비어담조92례，비교량조년령、성별、유무장기대량음주、주원천수、혈상규、간공능、HBV 혈청학표지물、HBV DNA등，장유차이적지표주이원 Logistic 회귀분석。결과급성화만성을간합병담즙어적성간병적비례분별위20.00％화1.14％（P ＝0.000）。급성을간어담조환자적년령（48.87±7.63）세、주원천수（34.6±11.3）d、외주혈단핵세포비례16.34（8.1～30.00）％、HBeAg 효개34.30（0.37～1442.24）S／CO、HBV DNA 정량6.46×105（1.21×102 ～ 1.25×107）고패／mL，AST／ALT 0.51±0.20균고우비어담조（P ＜0.05）；환자년령、외주혈단핵세포비례화 HBV DNA 수평시급성을간합병담즙어적성간병적위험인소（OR 치분별위 1.09、1.16、3.24，P ＜0.05）。결론급성을간합병담즙어적성간병적발생솔교만성을간고；환자년령、외주혈단핵세포비례화 HBV DNA 수평시급성을간합병담즙어적성간병적위험인소。
Objective To investigate clinical characteristics and risk factors for acute hepatitis B combined with cholestasis.Methods Patients with hepatitis B,including 115 of acute hepatitis and 263 of chronic hepatitis,from 2008 June to 2014 April, were enrolled. The analyzed data included age, gender, alcoholic consumption, onset time, hospitalization days,blood routine,liver function,hepatitis B virus (HBV)markers,HBV DNA load,and so on.All the data was analyzed with statistical software SPSS19.0.Results Proportion of hepatitis B patients combined with cholestasis was 20% in the acute group,and statistically higher than that of 1 .14% in chronic group.In acute hepatitis B group, patients with cholestasis were 48.87±7.63 years old,34.61 ±11 .3 days in hospitalization,16.34(8.1 -30.00)% in the ratio of peripheral blood mononuclear cell,34.30(0.37-1442.24)S/CO in HBeAg titer,6.46×105 (1 .21 ×102 -1 .25 × 107 )copies/mL in HBV DNA load,and 0.51 ±0.20 in ALT/AST ratio,which were significantly higher than those in patients without cholestasis,respectively.Age,ratio of peripheral blood mononuclear cell and HBV DNA level were risk factors for cholestasis in acute hepatitis B (OR = 1 .09,1 .16,and 3.24,respectively;P < 0.05 ).Conclusion Acute hepatitis B is prone to combine with cholestasis.Age,ratio of peripheral blood mononuclear cell and HBV DNA level are risk factors for cholestasis in acute hepatitis B.