棘球蚴病住院患者临床特征分析

doi:10.12140/j.issn.1000-7423.2021.01.009

摘要/Abstract

摘要：

目的分析青海省棘球蚴病住院患者的临床资料和治疗情况,为提高棘球蚴病的综合诊治效果提供科学依据。方法以青海省人民医院2016年1月—2019年6月收治的949例棘球蚴病住院患者临床资料为研究对象,收集患者的人口学信息及临床信息,采用EpiData 3.02软件进行数据双录入,以棘球蚴病是否治愈为因变量,对两型棘球蚴病的疾病转归进行单因素分析,并根据单因素分析结果,构建Logistic回归模型,分析影响棘球蚴病患者治愈的影响因素,应用SPSS 17.0统计学软件对数据进行统计分析。结果共整理了949例棘球蚴病患者临床资料,细粒棘球蚴病（cystic echinococcosis,CE）756例,其中男性350例,女性406例;多房棘球蚴病（alveolar echinococcosis,AE）193例,其中男性90例,女性103例,女性较男性略多;藏族CE 524例、AE 141例;职业以农牧民为主,CE 604例、AE 157例;文化程度均以文盲为主,CE 596例、AE 147例;CE以青海省玉树州多见（209例）,AE以青海省果洛州多见（93例）。临床症状腹部不适CE 579例,AE 140例;肝功能Child-Pugh分级A级CE 663例,AE 142例;超声声像学分型CE2（多子囊型）227例、CE4（实变型）302例、AE1（浸润型）162例;手术治疗CE 409例,AE 83例。CE疾病转归的单因素分析结果显示,不同性别、年龄段、包囊大小、超声声像学分型、有无并发症、是否手术组间转归不同（P < 0.01）;AE疾病转归的单因素分析结果显示,肝功能分级（P < 0.05）、是否手术（P < 0.01）组间转归不同。Logistic回归结果显示,影响CE患者治愈的主要因素为性别（P < 0.05）、包囊大小（P < 0.05）和是否手术（P < 0.01）,而影响AE患者治愈的主要因素仅为手术治疗（P < 0.01）。结论青海省两型棘球蚴病住院患者的临床资料分析结果显示,手术是提高两型棘球蚴病治愈率的主要治疗方式。

关键词: 棘球蚴病, 住院病例, 临床特征, 治疗情况, 疾病转归

Abstract:

Objective To analyze the clinical features and treatment of echinococcosis inpatients in Qinghai Province, in order to provide scientific basis for improvement of diagnosis and treatment of echinococcosis. Methods Demographic and clinical information of 949 echinococcosis inpatients in Qinghai Provincial People’s Hospital during January 2016 and June 2019 were collected and entered in database in duplicates by using the EpiData software 3.02. Univariate analysis was performed for the two types of echinococcosis, using hydatid disease as the dependent variable. Logistic regression model was constructed based on the univariate analysis results, in order to analyze factors influencing the treatment outcome of echinococcosis. Data were analyzed with the SPSS 17.0 software. Results Clinical information of 949 echinococcosis cases was collected, including 756 cystic echinococcosis (CE) cases comprising 350 males and 406 females, and 193 alveolar echinococcosis (AE) cases comprising 90 males and 103 females. There were 524 Tibetan CE cases and 141 Tibetan AE cases. The cases were mainly distributed in farmers and herdsmen, including 604 CE cases and 157 AE cases. Most of the cases were illiterate, including 596 CE cases and 147 AE cases. CE cases were mainly distributed in Yushu Prefecture (209 cases) and AE mainly in Guoluo Prefecture (93 cases). In addition, 548 CE cases and 141 AE cases had clinical symptoms of abdominal discomfort, while 663 CE cases and 142 AE cases had Child-Pugh stage A of liver functions. Ultrasound imaging classification revealed 227 cases of the CE2 type and 302 cases of the CE4 type, and the predominance of AE1 type among the AE cases. Moreover, 19.8% CE cases and 19.2% AE cases had complications; 409 CE cases and 83 AE cases received surgery. The univariate analysis of CE showed that gender, age, cyst size, ultrasonic image classification, the occurrence of complications and prognosis of surgery (P < 0.01) were different between groups. The univariate analysis of AE showed that the Child-Pugh score (P < 0.05) and prognosis of surgery (P < 0.01) were different between groups. Logistic regression results showed that the main factors influencing the cure of CE were gender (P < 0.05), cyst size (P < 0.05) and whether or not receiving surgery (P < 0.01), while surgery (P < 0.01) was the main factor influencing the cure of AE. Conclusion The clinical data of the two types of echinococosis in Qinghai Province suggest that surgery is an effective way to improve the cure rate of AE and CE.

Key words: Echinococcosis, Hospitalization cases, Clinical features, Treatment condition, Prognosis of disease

中图分类号:

R532.32

朱凌虹, 祝路民, 王勃, 杨智勇, 张静妮, 吉莉, 蔡其刚, 韩秀敏. 棘球蚴病住院患者临床特征分析[J]. 中国寄生虫学与寄生虫病杂志, 2021, 39(1): 61-68.

ZHU Ling-hong, ZHU Lu-min, WANG Bo, YANG Zhi-yong, ZHANG Jing-ni, JI Li, CAI Qi-gang, HAN Xiu-min. Analysis of clinical features of echinococcosis cases[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2021, 39(1): 61-68.

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变量 Variable	赋值 Assignment
年龄段Age	连续资料Continuous data
性别Gender	男Male = 0; 女Female = 1
入院肝功能Liver function	Child-Pugh A级= 1; Child-Pugh B级= 2;Child-Pugh C级= 3
病灶数量Cyst number	1个One = 10; 2个及以上Two and above = 01
包囊大小Cyst size	连续资料Continuous data
超声声像分型 Ultrasound imaging type	CE1（单囊型Single cyst type）= 10000; CE2（多子囊型Multiple-cyst type）= 01000; CE3（内囊塌陷型Internal capsule collapsed）=00100; CE4（实变型Consolidation type）=00010; CE5（钙化型Calcification type）=00001
	AE1（浸润型Infiltration type）= 100; AE2（病灶钙化型Foci calcification type）= 010; AE3（液化坏死型Liquefactive necrosis）= 001
有无并发症Complications	有Yes = 0; 无 No = 1
是否手术Surgery	是Yes = 0; 否No = 1

病例资料Medical records	细粒棘球蚴病 Cystic echinococcosis		多房棘球蚴病 Alveolar echinococcosis
病例资料Medical records	例数No. of cases	占比/% Proportion/%	例数No. of cases	占比/% Proportion/%
超声声像分型Ultrasound image type
CE1（单囊型Single cyst type）	107	14.2
CE2（多子囊型Multiple-cyst type）	227	30.0
CE3（内囊塌陷型Internal capsule collapsed）	21	2.8
CE4（实变型Consolidation type）	302	39.9
CE5（钙化型Calcification type）	99	13.1
AE1（浸润型Infiltration type）			162	83.9
AE2（病灶钙化型Foci calcification type）			18	9.3
AE3（液化坏死型Liquefactive necrosis）			13	6.8
有无并发症 Complications
无 No	606	80.2	156	80.8
有Yes	150	19.8	37	19.2
是否手术Surgery
是Yes	409	54.1	83	43.0
否 No	347	45.9	110	57.0

地区District	细粒棘球蚴病 Cystic echinococcosis		多房棘球蚴病 Alveolar echinococcosis
地区District	例数No. of cases	比例/% Proportion/%	例数No. of cases	比例/% Proportion/%
玉树 Yushu	209	27.6	42	21.8
果洛Guoluo	112	14.8	93	48.2
海北Haibei	51	6.7	2	1.0
海南Hainan	108	14.2	8	4.1
海西Haixi	35	4.6	0	0
黄南Huangnan	81	10.7	2	1.0
西宁Xining	103	13.6	31	16.1
海东Haidong	57	7.6	15	7.8
合计Total	756	100	193	100

特征Feature	细粒棘球蚴病Cystic echinococcosis				多房棘球蚴病Alveolar echinococcosis
特征Feature	未愈Uncured	治愈Cure	χ²	P	未愈Uncured	治愈Cure	χ²	P
性别Gender
男Male	203	147	13.050	< 0.01	65	25	0.003	> 0.05
女Female	182	224			74	29
年龄段Age
≤15	5	5	63.143	< 0.01	1	0	2.671	> 0.05
16~30	44	78			28	13
31~45	110	169			53	23
46~60	95	68			40	15
61~75	113	48			16	3
> 75	18	3			1	0
病灶数量Cyst number
1个One	286	262	1.273	> 0.05	98	43	1.646	> 0.05
2个及以上Two and more	99	109			41	11
包囊大小Cyst size
< 5 cm	39	133	74.844	< 0.01	10	9	3.949	> 0.05
5~10 cm	179	173			53	19
> 10 cm	153	79			76	26
肝功能Child-Pugh分级
A	331	332	3.619	> 0.05	94	48	9.898	< 0.01
B	49	38			35	6
C	5	1			10	0
超声声像分型 Ultrasound image type
CE1	61	46	66.439	< 0.01
CE2	138	89
CE3	11	10
CE4	148	154
CE5	13	86
AE1					114	48	5.419	> 0.05
AE2					17	1
AE3					8	5
有无并发症 Complications
无No	343	263	39.355	< 0.01	112	44	0.021	> 0.05
有Yes	42	108			27	10
是否手术Surgery
是Yes	51	358	527.307	< 0.01	30	53	93.017	< 0.01
否No	334	13			109	1

	变量Variable	偏回归系数B	标准误S. E.	Wald统计量Wald χ²	P 值P value	OR值OR value	95% CI
CE	性别Gender	0.724	0.277	6.804	< 0.05	2.062	1.197~3.553
	病灶数量Cyst number	0.016	0.009	0.013	> 0.05	1.016	0.772~1.337
	包囊大小Cyst size	0.501	0.207	5.863	< 0.05	1.650	1.100~2.476
	肝功能Child-Pugh分级Liver function Child-Pugh classification	-0.501	0.400	1.567	> 0.05	0.606	0.276~1.328
	超声声像分型Ultrasound image type			6.649	> 0.05
	CE1	0.469	0.579	0.654	> 0.05	1.598	0.513~4.972
	CE2	0.939	0.552	2.894	> 0.05	2.558	0.867~7.549
	CE3	0.771	0.934	0.681	> 0.05	2.161	0.347~13.479
	CE4	1.166	0.535	4.754	< 0.05	3.208	1.125~9.146
	手术Surgery	-5.072	0.347	213.313	< 0.01	0.006	0.003~0.012
	并发症Complications	0.582	0.353	2.717	> 0.05	1.789	0.896~3.574
	常数项Constant term	-0.383	0.723	0.281	> 0.05	0.682
AE	性别Gender	-0.574	0.497	1.334	> 0.05	0.563	0.213~1.492
	病灶数量Cyst number	0.013	0.253	0.002	> 0.05	1.013	0.616~1.664
	包囊大小Cyst size	0.110	0.381	0.083	> 0.05	1.116	0.529~2.355
	肝功能Child-Pugh分级Liver function Child-Pugh classification	-0.728	0.629	1.341	> 0.05	0.483	0.141~1.655
	超声声像分型Ultrasound image type			0.343	> 0.05
	AE1	0.284	0.802	0.125	> 0.05	1.328	0.276~6.397
	AE2	-0.389	1.608	0.059	> 0.05	0.678	0.029~15.824
	手术Surgery	-5.167	1.032	25.064	< 0.01	0.006	0.001~0.043
	并发症Complications	-0.732	0.637	1.317	> 0.05	0.481	0.138~1.678
	常数项Constant term	1.695	0.694	5.966	< 0.05	5.449