| Aims:1、To analyze the clinical characteristics of patients with acute hepatitis E2、To study the related risk factors and prognostic factors of acute(subacute)liver failureliver failure in patients with acute hepatitis E3、To analyze the clinical characteristics of patients with chronic hepatitis B overlapping HEV infection.Methods:1、The general situation(age,sex,etc.),clinical manifestations,whether there are extrahepatic diseases,and laboratory indicators(liver function,biochemistry,etc.)of 367 inpatients with acute hepatitis E who visited the First Hospital of Jilin University from January 1,2009 to December 31,2022 were continuously collected and sorted out.2、According to the inclusion and exclusion criteria,245 patients with pure HEV infection were divided into liver failure group and non-liver failure group according to whether acute or subacute liver failure occurred.The general data,related complications and laboratory indicators of the two groups were analyzed,and the statistically significant indicators were analyzed by multivariate analysis,so as to explore the risk factors of acute(subacute)liver failure in patients with pure HEV infection.Among 245 cases of pure HEV infection,141 patients completed long-term follow-up by telephone or consulting outpatient/inpatient medical records,and analyzed the factors related to prognosis.3 、 The clinical characteristics of 37 patients with chronic hepatitis B overlapping HEV infection(HBV+HEV group)and patients with simple HEV infection(HEV group)were compared and analyzed.Results:1、Analysis of overall clinical characteristics of patients with acute hepatitis EIn this study,367 patients with acute hepatitis E were enrolled,the ratio of male to female was about 4: 1,and the overall median age was 54(44.5,61.5)years.Among them,there were 272 cases(74.1%)with simple HEV infection,and 95cases(25.9%)with mixed or overlapping infection: 1 case with mixed HAV infection(0.2%);50 cases(13.6%)were infected with HBV.5 cases(1.4%)were infected with HCV.21 cases(5.7%)had overlapping alcoholic liver disease;Druginduced liver injury occurred in 3 cases(0.8%);4 cases(1.1%)were complicated with autoimmune liver disease;11 cases(3.0%)were complicated with cryptogenic cirrhosis.Among them,77 cases(21.0%)had chronic liver disease complicated with HEV infection,and 52 cases(14.4%)had cirrhosis.The main complaints were jaundice,fatigue,nausea,anorexia,etc.Among them,273 patients(74.4%)were admitted to hospital because of jaundice,which was the most common complaint.86patients(23.4%)with acute hepatitis E developed liver failure: 54 patients(14.7%)were infected by HEV alone;One case(0.2%)was infected by HEV mixed with HBV;31 cases(8.4%)were chronic liver disease complicated with HEV infection,with chronic hepatitis B being the most common(17 cases,4.6%),followed by chronic alcoholic liver disease(9 cases,2.4%).In 202 patients(55.0%),transaminase increased by more than 10 times,TBIL increased in 316 patients(86.1%)and ALB decreased in 354 patients(96.5%).Of the 367 patients,327 cases(89.10%)were cured and discharged,3 cases(0.8%)underwent liver transplantation(1 case of hepatitis B cirrhosis,1 case of chronic alcoholic liver disease and 1 case of cryptogenic cirrhosis),7 cases(1.9%)died after treatment(all patients were infected by HEV alone),and 31 cases(8.4%)were discharged automatically when their critical condition deteriorated.2、Risk and prognostic factors of acute(subacute)liver failure in patients with acute hepatitis E;According to the inclusion and exclusion criteria,52(21.2%)of 245 patients with HEV infection developed liver failure.Univariate analysis showed that 18 factors,such as age,infection,AST,ALT,CHE,ALB,TBIL,TBA,PTA,INR and WBC,were all related to acute(subacute)liver failure in patients with HEV infection.Multivariate analysis showed that WBC,ALT,PLT,TBIL and LYM were all independent risk factors for acute(subacute)liver failure in patients with HEV infection.Of the 245 patients,141(57.6%)were followed up,of which 104(73.6%)were alive in the non-liver failure group and 37(37.2%)in the liver failure group,of which 12(8.5%)died.37 patients with liver failure were divided into survival group(25 cases,67.6%)and death group(12 cases,32.4%).Univariate analysis showed that 12 indexes,such as AST,GGT,TBA,WBC and NEUT,combined with hepatic encephalopathy,gastrointestinal bleeding and acute kidney injury were related to the prognosis of patients with acute(subacute)liver failure infected by HEV alone.3 、 Clinical characteristics of chronic hepatitis B with overlapping HEV infection;According to the inclusion and exclusion criteria,there were 37 cases(10.1%)of chronic hepatitis B overlapping HEV infection(HBV+HEV group),including 17 cases of chronic hepatitis B(45.9%)and 20 cases of hepatitis B cirrhosis(54.1%).There were 245 cases(66.8%)of pure HEV infection(HEV group).The incidence of liver failure in HBV+HEV group(40.5%)was higher than that in HEV group(21.2%)(P<0.05).Compared with HEV group,HBV+HEV group had more abdominal distension and discomfort,and the incidence of SBP,INR and IBIL were higher,while AST,ALT,CHE,GGT,ALP,LYM,HB,PLT and PTA were lower,with statistical significance(P < 0.05).Conclusions:1.HEV infection mainly occurs in young adults,and the high incidence age is40-69 years old.Children and the elderly are relatively rare,and the incidence rate of males is higher than that of females,about 4:1.2.The increase of WBC,ALT,TBIL and the decrease of PLT and lymphocyte absolute value are the early warning factors of acute(subacute)liver failure in patients with HEV infection.3.Complications such as hepatic encephalopathy,gastrointestinal bleeding and acute kidney injury,indirect bilirubin,INR,WBC,neutrophil absolute value,lymphocyte absolute value,urea nitrogen,serum creatinine increase and AST,GGT,bile acid and PTA decrease are closely related to the prognosis of patients with acute(subacute)liver failure infected by HEV alone.4.The symptoms of digestive tract are more severe and the incidence of liver failure is higher after chronic hepatitis B overlapping HEV infection. |
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