饮酒、肥胖与脂肪肝关系的流行病学调查

目的探讨饮酒、肥胖与脂肪肝的关系。方法通过随机多级分层整群抽样,对上海市成人进行问卷调查、体检、血糖、血脂和B超检查。结果3175名调查对象中月饮酒率、肥胖、脂肪肝检出率分别为7.62%、41.9%和20.82%。661例脂肪肝中,非酒精性占92.43%、酒精性仅占3.48%。与对照组相比,过量饮酒和肥胖分别增加脂肪肝患病风险3.6倍(95%CI,1.1～11.7)和11.6倍(95%CI,8.2～16.5),而过量饮酒合并肥胖则增加脂肪肝患病风险17.1倍(95%CI,9.1～32.4);肥胖增加过量饮酒者脂肪肝患病风险4.8倍(95%CI,1.4～16.6),而过量饮酒并不能显著增加肥胖患者脂肪肝患病风险(OR=1.5,95%CI,0.9～2.6)。结论上海市成人脂肪肝患病率高且以非酒精性为主,肥胖与脂肪肝的关系较过量饮酒与脂肪肝的关系更为密切。     

Socio‐economic status predicts drinking patterns but not alcohol‐related consequences independently

Aim To identify independent relationships between socio‐economic status and drinking patterns and related consequences and to identify socio‐economic groups at risk for heavier consumption. Design and setting Three comparable national telephone surveys were utilized: 1995, 2000 and 2004. The respondents were aged 18–65 years. Contextual information includes that a number of liberalized alcohol policy changes occurred over the time of the surveys. Results Educational qualification, income and occupation were associated independently with alcohol consumption. There were indications that the different dimensions of drinking (quantity and frequency) had different relationships with socio‐economic status (SES). For example, lower SES groups drank heavier quantities while higher SES groups drank more frequently. SES, however, did not play a major role predicting drinking consequences once drinking patterns were controlled for, although there were some exceptions. It was the lower‐to‐average SES groups that were at greater risk for drinking heavier quantities compared to other SES groups in the population (as they had sustained increases in the quantities they consumed over time where other SES groups did not). Conclusion Socio‐economic status was related independently to drinking patterns and there were indications that SES interacted differently with the different dimensions of drinking (quantity and frequency). For the most part, socio‐economic status was not related independently to the experience of alcohol‐related consequences once drinking patterns were accounted for. It was the lower‐to‐average SES groups that were at greater risk for drinking heavier quantities compared to other SES groups in the population.     

Alcohol drinking patterns and biomarkers of coronary risk in the Spanish population

Background and aimsTo estimate the association between patterns of alcohol consumption and biomarkers of coronary heart disease (CHD) risk.Methods and resultsCross-sectional study among 10,793 individuals representative of the Spanish population aged ≥18 years. The threshold between moderate and heavy drinking was 40 g of alcohol/day in men and 24 g/day in women. Binge drinking was defined as intake of ≥80 g of alcohol in men and ≥60 g in women at any drinking occasion in the preceding 30 days. Analyses were performed with generalized linear models with adjustment for the main confounders, and results were expressed as the percentage change in the geometric mean (PCGM). Compared to non-drinkers, moderate and heavy drinkers had progressively higher serum HDL-cholesterol, with a PCGM ranging from 4.8% (95% CI: 3.7–6.0%) in moderate drinkers without binge drinking (MNB) to 9.6% (5.1–14.2%) in heavy drinkers with binge drinking (HB). Fibrinogen decreased progressively with alcohol intake, from −2.2% (−3.1 to −1.3%) in MNB to −5.8% (−9.4 to −2.0%) in HB. Leptin, glycated hemoglobin and the HOMA-index also decreased with increasing alcohol intake, and particularly with binge drinking.ConclusionsModerate alcohol intake is associated with improved HDL-cholesterol, fibrinogen and markers of glucose metabolism, which is consistent with the reduced CHD risk of moderate drinkers in many studies. Heavy and binge drinking were also associated with favorable levels of CHD biomarkers; since these drinking patterns produce substantial health harms, our results should not be used to promote alcohol consumption.     

Drinking habits as cofactors of risk for alcohol induced liver damage

Background—The Dionysos Study is a cohort studyof the prevalence of chronic liver disease in the general population oftwo northern Italian communities. It included 6917 subjects, aged 12-65 (69% of the total population).
Aims—The aim of this part of the study was toexamine the relationship of daily alcohol intake, type of alcoholicbeverage consumed, and drinking patterns to the presence of alcoholinduced liver damage in an open population.
Patients and methods—6534 subjects, free of virusrelated chronic liver disease and participating in the firstcross-sectional part of the study, were fully examined. Each subjectunderwent: (a) medical history and physical examination, (b) evaluationof alcohol intake using an illustrated dietary questionnaire, and (c)routine blood tests. More invasive diagnostic procedures were performedwhen indicated.
Results—Multivariate analysis showed that therisk threshold for developing either cirrhosis or non-cirrhotic liverdamage (NCLD) was ingestion of more than 30 g alcohol per day in both sexes. Using this definition, 1349 individuals (21% of the population studied) were at risk. Of these, only 74 (5.5% of the individuals atrisk) showed signs of liver damage. The prevalence of "pure" alcoholic cirrhosis was 0.43% (30 of 6917), representing 2.2% of theindividuals at risk, with a ratio of men to women of 9:1, while 44 (3.3% of the individuals at risk) showed persistent signs of NCLD.After 50 years of age, the cumulative risk of developing both NCLD andcirrhosis was significantly higher (p<0.0001) for those individualswho regularly drank alcohol both with and without food than for thosewho drank only at mealtimes.
Conclusions—Our data show that in an openpopulation the risk threshold for developing cirrhosis and NCLD is 30 gethanol/day, and this risk increases with increasing daily intake.Drinking alcohol outside mealtimes and drinking multiple differentalcoholic beverages both increase the risk of developing alcoholinduced liver damage.

Keywords:alcohol; liver disease; cirrhosis

     

脂肪性肝病与原发性肝癌

脂肪性肝病是隐原性肝硬化的主要原因之一,其经过肝硬化进展至原发性肝癌的过程已被认可,但是近年来越来越多的研究证实脂肪性肝病本身存在有促肿瘤形成的机制,它可以不经过肝硬化而直接进展成原发性肝癌,两者之间的具体机制还未明确.此文就脂肪性肝病向原发性肝癌进展的可能机制作一综述.     

Lifetime drinking history in patients with alcoholic liver disease and patients with alcohol use disorder without liver disease

Objective: To determine the differences in lifetime alcohol intake (LAI) and drinking patterns between patients with alcoholic liver disease (ALD) and alcohol use disorder (AUD) without notable liver injury and between males and females with ALD.

Methods: Alcohol drinking patterns were assessed using the Lifetime Drinking History (LDH) a validated questionnaire, during an outpatient visit. Patients with AUD, currently in addiction treatment, were matched for gender and age (±5 years) with the ALD group.

Results: A total of 39 patients with ALD (26 males and 13 females; median age 58) and equal number of AUD patients were included (median age 56 years). The onset age for alcohol drinking and duration of alcohol consumption was similar in ALD and AUD. The number of drinking days was higher in women with ALD than in women with AUD: 4075 [(3224–6504) versus 2092 (1296–3661), p?=?.0253]. The LAI and drinks per drinking day (DDD) were not significantly different between patients with ALD and AUD. Females with ALD had lower LAI than males with ALD: 32,934 (3224–6504) versus 50,923 (30,360–82,195), p?=?.0385, fewer DDD (p?=?.0112), and lower proportion of binge drinking as compared to males with ALD (p?=?.0274).

Conclusions: The total LAI was similar in patients with ALD and AUD. The number of drinking days over the lifetime was associated with the development of ALD in females. Females with ALD had significantly lower alcohol consumption than men with ALD despite similar duration in years of alcohol intake which supports the concept of female propensity of ALD.     

Association of self-reported alcohol use and hospitalization for an alcohol-related cause in Scotland: a record-linkage study of 23 183 individuals

Aims To investigate the extent to which self‐reported alcohol consumption level in the Scottish population is associated with first‐time hospital admission for an alcohol‐related cause. Design Observational record‐linkage study. Setting Scotland, 1995–2005. Participants A total of 23 183 respondents aged 16 and over who participated in the 1995, 1998 and 2003 Scottish Health Surveys, followed‐up via record‐linkage from interview date until 30 September 2005. Measurements Rate of first‐time hospital admission with at least one alcohol‐related diagnosis. Cox proportional hazards regression analysis was applied to estimate the relative risk of first‐time hospitalization with an alcohol‐related condition associated with usual alcohol consumption level (1–7, 8–14, 15–21, 22–35, 36–49, 50+ units/week and ex‐drinker, compared with <1 unit per week). Findings Of the SHS participants, 527 were hospitalized for an alcohol‐related cause during 135 313 person‐years of follow‐up [39 first admissions per 10 000 person‐years, 95% confidence interval (CI) 36–42]. Alcohol‐related hospitalization rates were considerably higher for males (61/10 000 person‐years, 95% CI 54–67) than for females (22/10 000 person‐years, 95% CI 18–26). Compared with the lowest alcohol consumption category (<1 unit per week), the relative risk of first‐time alcohol‐related admission increased with reported consumption: age‐adjusted hazard ratios ranged from 3 (1–5) for 1–7 units/week to 19 (10–37) for 50+ units/week (males); and from 2 (1–3) for 1–7 units/week to 28 (14–56) for 50+ units/week (females). After adjusting for age and usual alcohol consumption, the relative risk of first‐time alcohol‐related admission remained significantly higher for males reporting binge drinking and for both males and females residing in the most deprived localities. Conclusions Moderate and higher levels of usual alcohol consumption and binge drinking are serious risk factors for alcohol‐related hospitalization in the Scottish population. These findings contribute to our understanding of the relationship between alcohol intake and alcohol‐related morbidity.     

A quantification of alcohol-related mortality in New Zealand

Background: There are no published New Zealand (NZ) studies on alcohol drinking and total mortality, despite its importance to alcohol health policy.
Aims: To estimate the proportion of NZ deaths caused or prevented by alcohol drinking.
Methods: The proportion of current alcohol drinkers from recent NZ surveys, and pooled relative risks from a review of the international literature on alcohol and mortality, were used to calculate disease-specific population attributable risks. The number of deaths caused (or prevented) by alcohol were calculated for 1987 New Zealand deaths. Person-years of life lost (or saved) were calculated using recent NZ life tables.
Results: The association between alcohol and total mortality was related to age. Alcohol was estimated to have caused 3.0% of all deaths among 0–14 year olds and 20.1% of deaths among 15–34 year olds, mostly from road injuries. In contrast, alcohol was estimated to have prevented 0.5% of all deaths among 35–64 year olds and 3.4% of deaths among >65 year olds due to its protective effect against coronary heart disease. For all age groups, alcohol was estimated to have prevented 1.5% of deaths. However, the number of person-years of life lost among ages less than 35 years was greater than those saved in the older age groups, so that alcohol was estimated to have caused the loss of 9525 person-years of life for all ages combined.
Conclusions: The adverse effects of alcohol on total mortality are confined to age groups less than 35 years. Public health policy to minimise deaths from alcohol should be concentrated on this group.     

酒精相关性肝病肝移植术后再饮酒与生存分析

目的分析酒精相关性肝移植患者的术后复饮率及其生存情况。方法对单中心2005年4月至2013年6月期间因终末期肝病行肝移植的435例患者进行回顾性分析,其中以酒精性肝病为第一移植原因的患者13例,以酒精性肝病为次要移植原因的患者68例,分别调查术前戒酒时间、术后复饮、复饮酒量,Kaplan-Meier方法计算生存曲线。结果 435例患者平均随访时间52.2个月,以酒精性肝病为第一移植原因的患者术后复饮率高于以酒精性肝病为次要移植原因的患者(46.15%比13.24%,χ2=7.838,P=0.016)。非酒精相关性肝移植的354例患者8年生存率为81.4%;以酒精性肝病为第一移植原因13例肝移植患者8年生存率为100%;以酒精性肝病为次要移植原因的68例患者8年生存率为85.3%;三者差异无统计学意义(P=0.117)。81例酒精相关性肝移植患者移植前戒酒时间6个月与移植后再饮酒无相关。结论以酒精性肝病为第一移植原因的患者术后复饮率更高,酒精相关性肝移植患者术后有较好的远期生存。酒精相关性肝移植患者移植前戒酒时间6个月与移植后再饮酒无相关。     

Relationship between model for end-stage liver disease score and left ventricular function in patients with end-stage liver disease

BACKGROUND:Decreased cardiac contractility has been observed in cirrhosis,suggesting a latent cardiomyopathy in these patients.This study was designed to evaluate left ventricular structure and function in patients with end-stage liver disease by the model for end-stage liver disease(MELD) scoring system. METHODS:We recruited 82 patients(72 male,10 female; mean age 50.3±8.9 years)with end-stage liver disease who underwent orthotopic liver transplantation between January 2002 and May 2008.Seventy-eight patie...     

Selection criteria and decisions in 375 patients with liver disease,considered for liver transplantation during 1977–1985

ABSTRACT— We performed a prospective study on 375 patients with liver disease, 60% female, for whom orthotopic liver transplantation (OLT) was considered during 1977–1985. Fifty-four per cent had cirrhosis, 8.5% congenital/hereditary disorders, 25% malignant tumour, 6% benign tumour, 2% Budd-Chiari syndrome, 1.5% acute hepatic failure, 3% other diagnoses, and 10% were under 15 years of age. As of July Ist, 1985, 99 patients (47 chronic active/inactive cirrhosis (CAC/CIC), 28 primary biliary cirrhosis (PBC), five hepatocellular carcinoma (HCC), 19 other diagnoses) were accepted for OLT (median age 40 years, 10% under age 15). By that date, 45 patients (median age 42), had had an OLT (20 CAC/CIC, 15 PBC, three biliary atresia, two HCC, five other diagnoses). Fifty-four per cent (201 patients) were rejected for transplantation. The primary reasons for rejection were: no indication (11%), age (5%), other surgical procedures possible (3%), severe liver failure (14%), extrahepatic spread of liver tumour (11%), cardiovascular or pulmonary problems (2%), severe hepatic bone disease (1%), and miscellaneous (7%). Thirty per cent of the patients with CAC/CIC, 38% with PBC, 88% with HCC and 71% with biliary atresia were rejected. In the CAC/CIC, PBC and biliary atresia patients severe liver failure was the most frequent reason for rejection (62%, 50% and 60%, respectively). In HCC, extrahepatic tumour spread was the most frequent reason (72%) for rejection. In this category only two patients (7%) ultimately underwent liver transplantation.     

Diagnostic laparoscopy and liver disease: experience of 200 cases

Background : Laparoscopy is an old technique that is frequently used by gastroenterologists in America and Germany. With modern equipment it is now possible to perform this technique under local anaesthesia.
Aim : To evaluate the usefulness and safety of laparoscopic liver biopsy.
Methods : Liver biopsy was routinely performed by laparoscopy under local anaesthetic and sedation. A standard 5 mm laparoscope was used and a pneumoperitoneum induced with nitrous oxide.
Results : Two hundred consecutive patients were laporoscoped and underwent liver biopsy. In five patients the liver could not be visualised due to adhesions. Two patients had bleeds related to the procedure. Twenty-five patients had malignancy diagnosed by guided biopsy. Eight of these had been missed by ultrasound prior to paparoscopy. Cirrhosis was diagnosed laparoscopically in 72 patients. Histology was unable to confirm this diagnosis in four patients.
Conclusion : Laparoscopy can be performed safely and comfortably on patients with local anaesthetic and sedation. The visualisation of the liver can add valuable information to liver biopsy.     

Prognosis and life expectancy in chronic liver disease

The aim of the present study was to define prognosis and life expectancy in patients with chronic liver disease of different etiologies and to relate them to an age- and sex-matched normal population. After a follow-up of 15 years, life expectancy of 620 patients with chronic liver disease was retrospectively calculated and compared with an age- and sex-matched normal population. Among patients with cirrhosis, prognosis was dependent upon the Child classification (P=0.001). Patients with alcoholic cirrhosis and fatty liver disease were younger (P=0.01) and had a lower life expectancy than patients with other causes of chronic liver disease (P=0.004). Patients with hepatitis B and hepatitis C cirrhosis showed a comparable prognosis and a significantly lower life expectancy than the age- and sex-matched population. Cryptogenic and autoimmune liver diseases showed a comparable life expectancy but a significantly shorter life expectancy than the normal population. In patients with ₁-antitrypsin deficiency-associated cirrhosis, a high viral coinfection rate was found (P=0.01). For patients with noncirrhotic hemochromatosis, prognosis was poorer than that for the age- and sex-matched population. In patients with asymptomatic primary biliary cirrhosis, chronic persistent hepatitis B, and ₁-antitrypsin deficiency without cirrhosis, life expectancy was equal to that of the normal population. Prognosis and life expectancy in chronic liver disease depend on stage, cause, and symptoms of chronic liver disease; age; and possibilities of treatment. In patients with hereditary liver disease, additional viral infection or alcohol abuse lead to a significant deterioration of life expectancy. Patients with alcoholic chronic liver disease have the poorest prognosis.     

The characteristics and natural history of Japanese patients with nonalcoholic fatty liver disease.

AIMS: The aim of our study was to elucidate the characteristics and natural history of Japanese nonalcoholic fatty liver disease (NAFLD). PATIENTS AND METHODS: Two hundred and forty-seven patients were diagnosed as having biopsy-proven NAFLD at Tokyo Women's Medical University or an affiliated hospital from 1990 to June 2004. Biopsies were scored for the severity of steatosis, necro-inflammation, and fibrosis according to modified Brunt criteria. We assessed the clinicopathological features and natural history of NAFLD in patients stratified by the stage of their fibrosis. Univariate and multivariate logistic analyses were performed, and the diagnostic ability was assessed by the area under the receiver operating characteristic curve. RESULTS: Clinicopathological features: The median age of the patients was 53 years, with a range from 10 to 89 years. There were 130 males and 117 females. Histologically, 46 patients were classified as F3 (bridging fibrosis), and 43 patients had F4 (cirrhosis). Females and older patients were more common in the F3-4 patients. Most of the F3-4 patients showed mild elevation of transaminases with significant deterioration of liver function tests compared with F0-2 patients. Ten patients were simultaneously diagnosed as having cirrhotic NASH and hepatocellular carcinoma (HCC). Natural history: During follow-up (median 44 months) of the F3-4 patients, 10 patients developed liver-related morbidity and five patients developed HCC. In the F3-4 patients, the 5-year cumulative incidence of HCC was 20%. Eight patients died (two of liver failure, four of HCC and two of other carcinomas). Serum markers for detecting F3-4: Serum hyaluronic acid levels can accurately evaluate NAFLD patients with F3-4. CONCLUSIONS: The most important consequence of NAFLD patients with advanced fibrosis was HCC. Regular screening for this complication is extremely important.     

Drinking games,tailgating, and pregaming: Precollege predictors of risky college drinking

Background: The transition from high school to college is a critical period for developing college drinking habits. Hazardous alcohol consumption increases during this period, as well as participation in drinking games, pregaming, and tailgating. All of these risky drinking practices are associated with higher levels of intoxication as well as an increased risk of alcohol-related problems. Objective: The current study aimed to evaluate pre-college predictors (personality, social norms, and beliefs reflecting the internalization of the college drinking culture [ICDC]) of estimated peak BAC (pBAC) reached during drinking games, pregaming, and tailgating, as well as pBAC and alcohol-related problems during the first 30 days of college. Methods: Participants (n?=?936) were incoming freshmen at a large university who completed a baseline assessment prior to college matriculation and a follow-up assessment after they had been on campus for 30 days. Results: Using path analysis, ICDC was significantly associated with pBAC reached during the three risky drinking practices. ICDC had an indirect effect on both pBAC and alcohol-related problems via pBAC from drinking games, pregaming, and tailgating. Hopelessness and sensation seeking were significantly related to alcohol use outcomes. Conclusion: Precollege perceptions of the college drinking culture are a stronger predictor of subsequent alcohol use than social norms. Interventions that target these beliefs may reduce peak intoxication and associated harms experienced during the first 30 days of college.     

UPPS-P facets of impulsivity and alcohol use patterns in college and noncollege emerging adults

Background: Alcohol use and related problems reach a peak in emerging adulthood. Impulsivity is a multifaceted construct known to be involved in emerging adult alcohol use. Few studies have examined impulsivity and alcohol use across both college attending and noncollege attending emerging adults. Objectives: To clarify the multifaceted nature of impulsivity and its links to emerging adult alcohol use, this study investigated whether the five distinct facets of the UPPS-P model of impulsivity were predictive of three different behavioral outcomes: alcohol intake, alcohol related problems and binge drinking. In addition, the moderating effects of college attendance were tested. Methods: A community sample comprising 273 Australian college and noncollege attendees (58.6% women; 41.4% men) aged between 18 and 30 years (M_age = 23.71, SD = 2.81). Results: Multiple regression analyses demonstrated that lack of premeditation predicted alcohol intake and binge drinking behavior, whilst positive and negative urgency predicted alcohol related problems. Moderation analyses revealed that the effects of impulsivity on alcohol patterns were consistent for college and noncollege attending emerging adults. Conclusion: These findings highlight the importance of impulsive urgency (both positive and negative) in emerging adult problematic alcohol use, and support the generalizability of college samples to broader emerging adult populations. Emerging adults may use alcohol to avoid negative mood states and further enhance positive mood states. Improved emotional regulation may help both college and non-college emerging adults reduce their alcohol use.