發(fā)布時(shí)間：2018-05-27 06:20

  本文選題：丙型肝炎病毒 + 慢性丙型肝炎��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本研究旨在了解慢性丙型肝炎及丙型肝炎后肝硬化患者的人口學(xué)特征,行為生活方式、臨床特點(diǎn)等相關(guān)因素的暴露情況,用病例對(duì)照研究方法探討丙型肝炎后肝硬化的影響因素,為降低丙型肝炎后肝硬化的發(fā)生,提高患者的生活質(zhì)量提供科學(xué)依據(jù)。方法:收集2010年6月-2016年6月于山西省晉城市第三人民醫(yī)院及山西省晉城市人民醫(yī)院明確診斷為慢性丙型肝炎及丙型肝炎后肝硬化住院患者共219例作為研究對(duì)象,對(duì)所有研究對(duì)象,依據(jù)2016年更新版《丙型肝炎防治指南》及患者臨床癥狀、體征、生化檢查、影像學(xué)檢查結(jié)果分為兩組,一組為病例組,由丙型肝炎后肝硬化患者組成,一組為對(duì)照組,由慢性丙型肝炎患者組成,兩組均采集患者身高、體重,并計(jì)算身體質(zhì)量指數(shù),空腹采取靜脈血檢測(cè)丙氨酸氨基轉(zhuǎn)移酶(ALT)、門(mén)冬氨酸氨基轉(zhuǎn)移酶(AST)、白蛋白(ALB)、總膽固醇(TC)、甘油三酯(TG)、空腹血糖(FBG)以及丙肝抗體(抗-HCV)、丙型肝炎病毒量(HCV-RNA)、丙型肝炎基因分型等。采用?2進(jìn)行單因素分析,非條件logistic回歸進(jìn)行多因素分析。相乘交互作用采用logistic回歸模型分析。相加交互作用采用Andersson等[33]編制的Excel軟件進(jìn)行分析。結(jié)果:1.本次研究結(jié)果顯示:(1)研究對(duì)象中男女比例為1:1.46,女性占59.36%,男性占40.64%。(2)年齡大于等于60歲中丙型肝炎后肝硬化患者所占比例較高(52.94%),50~60歲及40~50歲中丙型肝炎后肝硬化患者所占比例分別為23.53%和22.35%,小于40歲的丙型肝炎后肝硬化患者所占比例較低,單因素分析差異有統(tǒng)計(jì)學(xué)意義(?2=32.390,P0.001)。(3)已婚的丙型肝炎后肝硬化患者所占比例為98.82%,高于未婚丙型肝炎后肝硬化患者(1.18%)。但無(wú)統(tǒng)計(jì)學(xué)意義(?2=2.421,P=0.121)。職業(yè)為農(nóng)民和工人的丙型肝炎后肝硬化患者所占比例為71.76%,其他職業(yè)丙型肝炎后肝硬化患者所占比例為28.24%,差異無(wú)統(tǒng)計(jì)學(xué)意義(?2=0.51,P=0.473)。2.影響丙型肝炎后肝硬化的單因素分析顯示:吸煙、有肝病家族史、感染后有明顯臨床表現(xiàn)、合并HBV感染、糖尿病、高血壓,未接受抗病毒治療、AST≥40U/L、PTA80%、感染年限為1~3年者增加丙型肝炎后肝硬化的發(fā)病風(fēng)險(xiǎn),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.影響丙型肝炎后肝硬化的多因素分析顯示:控制性別、年齡、是否吸煙、是否有乙肝家族史、是否合并HBV感染、是否合并高血壓、PTA80%、丙型肝炎基因分型后,感染年限長(zhǎng)(OR,OR95%CI:3.047,1.010~9.192;3.327,1.344~8.239)、感染后有明顯臨床表現(xiàn)(OR,OR95%CI:5.797,2.558~13.137)、合并糖尿病(OR,OR95%CI:7.169,2.182~23.557)、AST≥40U/L(OR,OR95%CI:3.242,1.496~7.024)、BMI≥28(OR,OR95%CI:2.663,1.160~6.114)是丙型肝炎后肝硬化的危險(xiǎn)因素;接受抗病毒治療(OR,OR95%CI:0.370,0.165~0.833)是丙型肝炎后肝硬化的保護(hù)因素。4.交互作用結(jié)果顯示:各因素之間未發(fā)現(xiàn)有相乘和相加交互作用。結(jié)論:慢性丙型肝炎患者中,感染年限較長(zhǎng)、感染后有明顯臨床表現(xiàn)、合并糖尿病、AST升高及肥胖者,會(huì)增加其發(fā)展為丙型肝炎后肝硬化的風(fēng)險(xiǎn);而接受正規(guī)抗病毒治療者,可以降低丙型肝炎后肝硬化的發(fā)生風(fēng)險(xiǎn)。
[Abstract]:Objective: This study aims to understand the demographic characteristics, behavioral lifestyle, clinical characteristics and other related factors of chronic hepatitis C and HCV patients, and to explore the influencing factors of post hepatitis C cirrhosis by case control study, in order to reduce the incidence of HCV and improve the life of patients with hepatitis C. Methods: a total of 219 cases of hospitalized patients with chronic hepatitis C and hepatitis C were diagnosed in the third people's Hospital of Jincheng, Jincheng, Shanxi, and the people's Hospital of Jincheng, Shanxi Province, June 2010, in June -2016 years. The clinical symptoms, signs, biochemical tests, and imaging findings were divided into two groups. One group was a case group, composed of patients with hepatitis C and cirrhosis, a control group, a control group, a chronic hepatitis C patient, and two groups of patients who were measured in height, weight, and calculated body mass index, and vierine venous blood was used to detect alanine aminoamine. Transferase (ALT), aspartate aminotransferase (AST), albumin (ALB), total cholesterol (TC), triglyceride (TG), fasting blood glucose (FBG), hepatitis C antibody (anti -HCV), hepatitis C virus (HCV-RNA), hepatitis C gene typing, and so on. Use? 2 for single factor analysis and non conditional logistic regression for multifactor analysis. Multiplicative interaction The logistic regression model was used to analyze the addition of Excel software such as Andersson and other [33]. Results: 1. the results of the study showed: (1) the proportion of men and women in the study was 1:1.46, women accounted for 59.36%, and the male accounted for (2) age greater than 60 years of hepatitis C (52.94%), 50~6 The proportion of patients aged 0 and 40~50 was 23.53% and 22.35% respectively, and the proportion of patients less than 40 years old was lower. The difference in single factor analysis was statistically significant (? 2=32.390, P0.001). (3) the proportion of patients with hepatitis C after hepatitis C was 98.82%, higher than that of unmarried hepatitis C. Liver cirrhosis (1.18%). But there is no statistical significance (? 2=2.421, P=0.121). The proportion of patients with post hepatitis C cirrhosis in the occupation is 71.76%, the proportion of other occupational hepatitis C patients is 28.24%, the difference is not statistically significant (? 2= 0.51, P=0.473).2. affects the single factor analysis of hepatitis C cirrhosis It shows: smoking, family history of liver disease, obvious clinical manifestation after infection, combined with HBV infection, diabetes, hypertension, unreceived antiviral treatment, AST > 40U/L, PTA80%, 1~3 years of infection increase the risk of hepatitis C cirrhosis, the difference is statistically significant (P0.05).3. affects the multiple factors analysis of hepatitis C after hepatitis C Show: control sex, age, smoking, family history of hepatitis B, HBV infection, combined hypertension, PTA80%, hepatitis C genotyping, infection years (OR, OR95%CI:3.047,1.010~9.192; 3.327,1.344~8.239), after infection (OR, OR95%CI:5.797,2.558~13.137), combined with diabetes (OR, OR95%CI:7.169). 2.182~23.557), AST > 40U/L (OR, OR95%CI:3.242,1.496~7.024), BMI > 28 (OR, OR95%CI:2.663,1.160~6.114) is a risk factor for posthepatitic cirrhosis; the acceptance of antiviral therapy (OR, OR95%CI:0.370,0.165~0.833) is a protective factor for the protection factor of hepatitis C after hepatitis C, and the result shows that there is no multiplication and phase between the factors. Conclusion: in patients with chronic hepatitis C, there is a long period of infection and obvious clinical manifestation after infection. The combination of diabetes, elevated AST and obesity will increase the risk of the development of HCV after hepatitis C, and the risk of cirrhosis after hepatitis C can be reduced by regular antiviral therapy.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R512.63;R575.2

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