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目的探讨老年肝硬化的临床特点。方法回顾性分析1998年1月-2010年12月收治的67例老年(年龄≥60岁)肝硬化患者的临床资料,并与72例非老年(年龄<60岁)肝硬化患者进行比较。结果老年组发生黄疸、腹水、白蛋白降低的几率高于非老年组,差异有统计学意义(P<0.05)。老年肝硬化患者的并发症较多,如电解质紊乱、感染、消化道出血、肝性脑病、肝癌、肝肾综合征、肝肺综合征,其发生率均高于非老年肝硬化患者,除肝肾综合征的发生率比较差异无统计学意义(P>0.05)外,其余并发症发生率比较差异均有统计学意义(P<0.05)。引起肝硬化的病因在老年组和非老年组是相同的,最常见病因为乙型肝炎病毒感染,其次为慢性酒精中毒。但非老年组乙型肝炎和非酒精性脂肪性肝炎比老年组多见(P<0.05),老年组慢性酒精中毒、胆汁淤积、药物与毒物中毒和肝脏血液循环障碍比非老年组多见(P<0.05)。老年组肝功能Child-Pugh分级以C级较多,与非老年组C级比较差异有统计学意义(P<0.05);非老年组以A级较多,与老年组A级比较差异有统计学意义(P<0.05)。老年组死亡26例,病死率为38.8%;非老年组死亡13例,病死率为18.1%,两组病死率比较差异有统计学意义(P<0.05)。非老年组的死亡原因主要为消化道出血、电解质紊乱,老年组的死亡原因主要为感染、消化道出血、电解质紊乱和肝性脑病。结论老年肝硬化在病因、临床表现、预后等方面与非老年肝硬化是不同的,积极治疗老年肝硬化的并发症非常重要。
Objective To investigate the clinical features of elderly patients with liver cirrhosis. Methods The clinical data of 67 elderly patients (≥60 years old) with cirrhosis admitted from January 1998 to December 2010 were retrospectively analyzed. The data were compared with those of 72 non-elderly patients (aged <60 years) with cirrhosis. Results The incidence of jaundice, ascites and albumin in elderly group was higher than that in non-elderly group (P <0.05). Complications of elderly patients with liver cirrhosis are more, such as electrolyte imbalance, infection, gastrointestinal bleeding, hepatic encephalopathy, liver cancer, liver and kidney syndrome, hepatopulmonary syndrome, the incidence was higher than non-elderly patients with cirrhosis, in addition to liver The incidence of renal syndrome was no significant difference (P> 0.05), the other complication rates were significantly different (P <0.05). The cause of cirrhosis is the same in the elderly and non-elderly groups, with the most common cause being Hepatitis B virus infection followed by chronic alcoholism. However, hepatitis B and nonalcoholic steatohepatitis were more common in the non-elderly group than in the elderly group (P <0.05). Chronic alcoholism, cholestasis, drug and poisoning, and hepatic blood circulation disorders were more common in the elderly group than in the non-elderly group P <0.05). Child-Pugh grading of liver function in the elderly group was more in class C than in non-elderly group (P <0.05), while in non-elderly group, there was more grade A and there was statistical difference with grade A in elderly group Significance (P <0.05). 26 cases died in the elderly group, the case fatality rate was 38.8%; 13 cases died in non-elderly group, the case fatality rate was 18.1%. There was significant difference between the two groups (P <0.05). The causes of death in the non-elderly group were mainly gastrointestinal bleeding and electrolyte imbalance. The main causes of death in the elderly group were infection, gastrointestinal bleeding, electrolyte imbalance and hepatic encephalopathy. Conclusions Elderly cirrhosis is different from non-elderly cirrhosis in terms of etiology, clinical manifestations and prognosis, and it is very important to actively treat the complications of senile cirrhosis.