The Korean Journal of Gastroenterology (대한소화기학회지)

The Korean Society of Gastroenterology (대한소화기학회)
권호 표지

Clinical Features of Acute Hepatitis A in Recent Two Years

최근 2년간 발생한 급성 A형간염의 임상 특성에 관한 연구

Lee, Eung-Jun;Kwon, So-Young;Seo, Tae-Ho;Yun, Hyun-Sung;Cho, Han-Su;Kim, Byung-Kook;Choe, Won-Hyeok;Lee, Chang-Hong;Kim, Jin-Nam;Yim, Hyung-Joon
이응준;권소영;서태호;윤현성;조한수;김병국;최원혁;이창홍;김진남;임형준

  • Published : 20081100
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Abstract

Background/Aims: The purpose of this study was to characterize the clinical features of acute hepatitis A in Seoul and Gyeonggi province during the recent 2 years. Methods: We reviewed the medical records of 222 patients who were diagnosed as acute hepatitis A between August 2005 and March 2007 at the Konkuk University Hospital and Korea University, Ansan Hospital. The clinical manifestation, serological tests, and image findings were analyzed. Results: Median age of the patients was 28.1 years and the age groups of highest incidence were the second and third decade. The frequent symptoms were anorexia (66.4%), fatigue (49.2%), fever (47.7%), and abdominal discomfort (42.5%). Fourteen cases (6.3%) showed renal insufficiency, and hemodialysis was performed in one. Cholestatic hepatitis in 2 cases, relapsing hepatitis in 4 cases and prolonged hepatitis in 13 cases were observed. However, there was no case of fulminant hepatitis or death. The underlying diseases including chronic hepatitis B, diabetes mellitus and thyroid disorder did not affect the disease severity of hepatitis A. IgM anti-HAV was not detected initially in 6.7% of the patients. Anti-HEV (IgM) was detected simultaneously in 3 of 150 patients. Conclusions: The age of patients with acute hepatitis A has been increased in the recent years. Most patients recovered uneventfully. However, unusual patterns of severe hepatitis and renal insufficiency occurred in considerable number of cases. Follow-up serologic test for IgM anti-HAV is needed in seronegative cases with hepatitis A. (Korean J Gastroenterol 2008;52:298-303)

목적: A형간염은 미감염자의 연령층이 점차 증가하면서 현증 급성 A형간염 환자의 발생이 증가하고 있고, 심한 간염의 임상 경과를 보이는 예들도 점차 증가하고 있다. 최근 18개월 동안 서울지역과 안산지역에서 산발적으로 발생한 급성 A형간염 환자의 임상, 혈청학적인 특성을 조사하였다. 대상 및 방법: 2005년 8월부터 2007년 3월까지 서울의 건국 대학교병원과 안산의 고려대학교안산병원에서 급성 A형간염으로 진단된 총 222예를 대상으로 간염 발생의 양상 및 임상 경과를 후향 분석하였다. 결과: 대상 환자의 나이 중앙값은 28세(3-50세)였고, 남녀 비는 129:93이었다. 연령별 분포는 15-20세가 17예(7.6%), 21-25세가 56예(25.2%), 26-30 세가 76예(34.2%), 31-35세가 44예(19.8%), 36세 이상이 29예(13.6%)였다. 월별 환자 분포는 6월에 10월 사이에 발생 빈도가 비교적 높았으나 유의한 차이를 보이지는 않았다. 경과 중 혈청 creatinine 수치가 1.5 mg/dL 이상의 신기능 장애를 보인 환자는 14예(6.3%), 담즙정체 간염이 2예(0.8%), 재발 간염이 4예(1.8%), ALT 수치가 3개월 이상 정상 범위를 초과한 지속 간염이 13예(5.8%)였고, 전격 간염은 없었다. 평균 최고 AST와 ALT는 각각 1,778±1,645 IU/L, 2,340±1,802 IU/L이었고, 평균 최고 총 빌리루빈은 6.88±5.04 mg/dL이었다. 복부초음파검사의 44.4%에서 정상 소견이었고, 비장 종대와 지방간 소견이 흔하게 관찰되었다. 내원 당시 IgManti-HAV가 음성이었으나 추적 검사 후 양성으로 진단된 경우가 15예(6.7%)였으며, 이들 환자는 내원 당시 IgM anti-HAV 양성 환자들에 비하여 발열, 오심, 구토 등의 임상 증상이 더 빈번하였다. 기저 질환으로서는 만성 B형간염 병력을 가진 환자는 8예(3.6%), 당뇨 병력을 가진 환자는 3예(1.3%)였으나 기저 질환에 따른 간염의 중증도 차이는 없었다. 결론: 급성 A형간염은 대부분에서 심각한 합병증 없이 회복되지만, 과거에 비하여 발병 연령이 높아지고 계절에 관계없이 산발적으로 발생하였다. 대부분의 환자는 심각한 합병증 없이 회복되지만, 비전형적인 임상 경과를 보이는 경우도 적지 않았다. 간염의 초기에 내원한 일부 환자에서는 IgM anti-HAV가 검출되지 않을 수 있으므로, A형간염이 임상적으로 의심된다면 항체 추적 검사가 필요하다.

Keywords

References

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