BMC Gastroenterology:酒精对肝炎病毒性肝硬化临床并发症的影响

2022-03-20 MedSci原创 MedSci原创

酒精性肝病(alcoholic liver disease)是由于长期大量饮酒导致的肝脏疾病。初期通常表现为脂肪肝,进而可发展成酒精性肝炎、肝纤维化和肝硬化。

      酒精使用障碍、乙肝病毒感染(HBV) 和 丙肝病毒感染(HCV) 是全球和中国肝硬化的三大主要原因。据估计,全球每年与 HCV 相关疾病(包括肝硬化和 HCC)相关的死亡人数约为 700,000。迄今为止,全世界估计有超过 3.5 亿人慢性感染 HBV,同时中国的实际社会经济发展参与了中国酒精相关肝病 (ALD) 患病率的上升,导致并存 ALD 和乙型或丙型肝炎病毒患者(ALD+ HBV、ALD+HCV)的病例增加。据世界卫生组织称,每年有超过 300 万人死于大量饮酒。这约占全球总死亡人数的 6%。ALD 是一系列疾病,从脂肪变性到脂肪性肝炎、纤维化甚至肝癌。常规用于诊断 ALD 的生物标志物包括 MCV 和 GGT 升高、AST/ALT 大于 1.5 等。尽管这些标志物的特异性和敏感性有限,但它们仍然在 ALD 的怀疑和诊断中发挥着重要作用。酒精与乙型或丙型肝炎病毒之间的相互作用最近得到了广泛的研究,但结论不一致。大量饮酒已被证明会加速肝纤维化的发展,并增加 HCV 感染患者的 HCC 患病率和死亡率。关于酒精和 HBV 之间的相互作用,尚无定论的研究。本研究旨在探究酒精对乙型和丙型肝炎病毒引起的肝硬化患者的实验室值和临床结果的影响。

 

      研究人员将2010年1月至2019年12月间诊断为肝硬化的患者(n=22287)根据病因分为5组:酒精性肝病组(ALD,1652例)、乙型肝炎病毒组(HBV,18079例)、丙型肝炎病毒组(HCV,682例)、ALD+HBV组(1594例)和ALD+HCV组(280例)。通过数据分析比较各组的实验室结果和不同肝硬化并发症的比例。

 

      研究结果显示:Child Pugh C 级(28.0% vs 18.8%,P  < 0.001)或 MELD 大于 18(24.1% vs 18.5%,P < 0.001) 在 ALD + HBV 组中显着超过 HBV 组。多因素logistic回归显示,ALD+HBV组发生肝细胞癌(HCC)和食管胃底静脉曲张破裂出血(EGVB)的风险分别是HBV组的2.01倍和1.74倍(HCC:OR=2.01, 95% CI [1.58–2.55];EGVB:OR = 1.74, 95% CI [1.30–2.33])。此外,线性分析测试表明,随着戒酒时间的延长,HCC 和 EGVB 的风险降低。此外,与未接受任何治疗的人、单独戒酒的人和单独接受抗病毒治疗的人相比,同时接受抗病毒治疗和戒酒的患者发生 HCC 和 EGVB 的风险最低(HCC:OR = 0.10, 95% CI [0.05–0.20], P<0.001;EGVB: OR = 0.17, 95% CI [0.06– 0.45],P<0.001) 。

图:不同类型肝炎患者肝硬化水平

 

      本项研究证实在肝炎病毒引起的肝硬化患者中,大量饮酒会增加肝功能损害的严重程度以及 HCC 和 EGVB 的患病率。值得注意的是,长期戒酒加上抗病毒治疗有效降低了这些人群患 HCC 和 EGVB 的风险。

 

 

原始出处:

Kodjo-Kunale Abassa. Et al. Effect of alcohol on clinical complications of hepatitis virus-induced liver cirrhosis: a consecutive ten-year study. BMC Gastroenterology.2022.

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    2022-12-17 丁鹏鹏
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    2022-10-09 许安
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    2022-09-28 howi
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