15年间到三级医院就诊的肝硬化患者特征的变化：韩国一项回

StephenW

Changes in Characteristics of Patients with Liver Cirrhosis Visiting a Tertiary Hospital over 15 Years: a Retrospective Multi-Center Study in Korea
Won Young Jang  1 , Woo Jin Chung  2 , Byoung Kuk Jang  1 , Jae Seok Hwang  1 , Heon Ju Lee  3 , Moon Joo Hwang  3 , Young Oh Kweon  4 , Won Young Tak  4 , Soo Young Park  4 , Su Hyun Lee  4 , Chang Hyeong Lee  5 , Byung Seok Kim  5 , Si Hye Kim  5 , Jeong Ill Suh  6 , Jun Gi Park  6
Affiliations

    PMID: 32715667 DOI: 10.3346/jkms.2020.35.e233

Abstract

Background: Liver cirrhosis has become a heavy burden not only for patients, but also for our society. However, little is known about the recent changes in clinical outcomes and characteristics of patients with cirrhosis-related complications in Korea. Therefore, we aimed to evaluate changes in characteristics of patients with liver cirrhosis in Daegu-Gyeongbuk province in Korea over the past 15 years.

Methods: We retrospectively reviewed the medical records of 15,716 liver cirrhotic patients from 5 university hospitals in Daegu-Gyeongbuk province from 2000 to 2014. The Korean Standard Classification of Diseases-6 code associated with cirrhosis was investigated through medical records and classified according to the year of first visit.

Results: A total of 15,716 patients was diagnosed with cirrhosis. A number of patients newly diagnosed with cirrhosis has decreased each year. In 2000, patients were most likely to be diagnosed with hepatitis B virus (HBV) cirrhosis, followed by alcoholic cirrhosis. There was a significant decrease in HBV (P < 0.001), but alcohol, hepatitis C virus (HCV), and non-alcoholic fatty liver disease (NAFLD) showed a significant increase during the study period (alcohol, P = 0.036; HCV, P = 0.001; NAFLD, P = 0.001). At the time of initial diagnosis, the ratio of Child-Turcotte-Pugh (CTP) class A gradually increased from 23.1% to 32.9% (P < 0.001). The most common cause of liver-related hospitalization in 2000 was hepatocellular carcinoma (HCC) (25.5%); in 2014, gastrointestinal bleeding with esophageal and gastric varices (21.4%) was the most common cause. Cases of hospitalization with liver-related complication represented 76.4% of all cases in 2000 but 70.9% in 2014. Incidence rate of HCC has recently increased. In addition, HCC-free survival was significantly lower in CTP class A than in classes B and C. Finally, there was significant difference in HCC occurrence according to causes (P < 0.001). HBV and HCV cirrhosis had lower HCC-free survival than alcoholic and NAFLD cirrhosis.

Conclusion: In recent years, the overall number of cirrhosis patients has decreased. This study confirmed the recent trend in decrease of cirrhosis, especially of cirrhosis due to HBV, and the increase of HCV, alcoholic and NAFLD cirrhosis. Targeted screening for at-risk patients will facilitate early detection of liver diseases allowing effective intervention and may have decreased the development of cirrhosis and its complications.

Keywords: Epidemiology; Hepatocellular Carcinoma; Liver Cirrhosis.

© 2020 The Korean Academy of Medical Sciences.

StephenW

15年间到三级医院就诊的肝硬化患者特征的变化：韩国一项回顾性多中心研究
元英章1，胡镇忠2，炳国章1，宰锡黄1，权祖利3，文柱黄3，杨吴权4，元英德4，秀英公园4，苏贤利4，张亨利5，边硕金5，司慧金5，郑一秀6，准基公园6
隶属关系

    PMID：32715667 DOI：10.3346 / jkms.2020.35.e233

抽象

背景：肝硬化不仅对患者而且对我们的社会都是沉重的负担。但是，对于韩国肝硬化相关并发症患者的临床结局和特征的最新变化知之甚少。因此，我们旨在评估韩国大邱庆北地区过去15年中肝硬化患者的特征变化。

方法：我们回顾性回顾了2000年至2014年大邱庆北地区5所大学医院的15716例肝硬化患者的病历。通过病历调查对与肝硬化相关的《韩国疾病分类标准》 -6编码进行了分类，并按年份进行了分类的第一次访问。

结果：共有15716例患者被诊断为肝硬化。每年新诊断为肝硬化的患者数量都有所减少。在2000年，患者最有可能被诊断出患有乙型肝炎病毒（HBV）肝硬化，然后是酒精性肝硬化。 HBV显着降低（P <0.001），但酒精，丙型肝炎病毒（HCV）和非酒精性脂肪肝疾病（NAFLD）在研究期间显着增加（酒精，P = 0.036； HCV， P = 0.001； NAFLD，P = 0.001）。在最初诊断时，A级儿童-Turcotte-Pugh（CTP）的比例从23.1％逐渐增加到32.9％（P <0.001）。 2000年与肝有关的住院最常见的原因是肝细胞癌（HCC）（25.5％）； 2014年，最常见的原因是食道和胃底静脉曲张引起的胃肠道出血（21.4％）。肝相关并发症住院的病例在2000年占所有病例的76.4％，而在2014年占70.9％。HCC的发病率最近有所上升。此外，A类CTP的无HCC生存率显着低于B类和C类。最后，根据原因，HCC发生率存在显着差异（P <0.001）。 HBV和HCV肝硬化的无HCC生存率低于酒精和NAFLD肝硬化。

结论：近年来，肝硬化患者的总数有所减少。这项研究证实了近年来肝硬化减少的趋势，特别是由于HBV引起的肝硬化，以及HCV，酒精性和NAFLD肝硬化的增加。针对高危患者的靶向筛查将有助于早期发现肝病，从而可以进行有效干预，并且可能减少肝硬化及其并发症的发生。

关键词：流行病学；肝细胞癌；肝硬化。

©2020韩国医学科学院。

StephenW

https://jkms.org/Synapse/Data/PDFData/0063JKMS/jkms-35-e233.pdf