Synergism of chronic alcoholism and hepatitis B infection in liver disease

One hundred and fifty-seven patients with alcoholic liver disease were studied. Hepatitis B surface antigen (HBsAg) was positive in 20.4% of the patients. Those who were positive for the HBsAg presented at an earlier age, had a lower albumin level, a higher globulin level, a more prolonged prothrombin time, were more likely to have features of cirrhosis in the liver biopsy, and were probably more likely to suffer from hepatic encephalopathy in the follow-up compared with those negative for HBsAg. The mortality of subjects was low both on admission and during follow-up. It is concluded that chronic alcoholism and hepatitis B virus infection act synergistically in producing more severe liver damage and causing cirrhosis at a younger age compared with chronic alcoholism alone. One possible reason for the low mortality of the patients might have been their relatively good nutritional status.     

Prevalence of anti-HCV among Chinese patients with acute and chronic liver disease

To assess whether the hepatitis C virus plays an important role in Chinese patients with acute and chronic liver disease, antibodies to HCV (anti-HCV) were measured by enzyme immunoassay in 67 patients with type A and B acute viral hepatitis, 165 patients with non-A, non-B (NANB) hepatitis, 438 patients with chronic hepatitis, 200 patients with postnecrotic liver cirrhosis, 72 patients with alcoholic liver disease, 55 patients with non-alcoholic fatty liver, 24 patients with toxic and drug-induced hepatitis, and 20 patients with other chronic liver diseases. Anti-HCV was not detected in sera from patients with type A and B acute viral hepatitis, toxic and drug-induced hepatitis, primary biliary cirrhosis, Wilson's disease, or lupoid hepatitis. The anti-HCV prevalence was found to be highest in patients with NANB hepatitis (59% in sporadic and 73.2% in transfusion-associated), 16.4% in non-alcoholic fatty liver, 5.6% in alcoholic liver disease, 6.8% in chronic hepatitis, and 16% in postnecrotic liver cirrhosis. In patients with chronic hepatitis, the anti-HCV prevalence was significantly higher in HBsAg-negative (15/34, 44.1%) than in HBsAg-positive cases (15/404, 3.7%; P less than 0.0001). The results indicate that HCV is a major agent of NANB hepatitis and plays an important role in HBsAg-negative chronic liver disease in Taiwan.     

植物凝集素亲和色谱层析法分离缺糖基转铁蛋白诊断酒精性肝病的临床研究

目的:观察酒精性肝病患者血清缺糖基转铁蛋白(CDT)水平变化,探讨CDT诊断酒精性肝病的临床价值.方法:应用植物凝集素亲和层析法分离血清CDT和正常转铁蛋白(Tf),然后应用ELISA技术分别测定酒精性肝病组患者及正常对照组人员CDT和Tf,最后计算CDT/Tf值.结果:两组人员血清植物凝集素亲和层析洗脱图谱均显示两个洗脱峰;CDT存在于第一洗脱峰,Tf存在于第二洗脱峰,ELISA定量结果显示:酒精性肝病组患者血清CDT平均水平为5.05±1.64,Tf平均水平为54.91±40.94,CDT/Tf值为0.123,正常对照组人员血清CDT平均水平为4.78±1.03,Tf平均水平451.61±241.37,CDT/Tf值为0.0117,经统计学分析,P＜0.05,差异有显著性意义.结论:酒精性肝病患者血清CDT水平及CDT/Tf值明显升高,CDT是诊断酒精性肝病良好的生化标志.     

Differences of liver membrane antibody frequency in alcoholic liver disease

The presence of liver membrane antibody in IgG and IgA was investigated by radioimmunoassay using isolated rabbit hepatocytes as target cells. This technique was more sensitive than the immunofluorescent method. IgG liver membrane antibodies were positive in 24% of patients with alcoholic liver disease. IgA liver membrane antibodies were detected in 58% of patients with alcoholic liver disease, whereas they were detected only in 21% of those with nonalcoholic liver disease, except for cases of autoimmune chronic active hepatitis. In alcoholic liver disease, IgA liver membrane antibodies were detected at a high frequency in a group of patients with alcoholic hepatitis and active cirrhosis (94%) as compared with that of fatty liver, hepatic fibrosis, and inactive cirrhosis (42%). These results suggest that alcoholic liver disease is characterized in part by a humoral immune response of IgA liver membrane antibodies.This study was supported in part by grants 59480207 and 60304058 from the Japanese Ministry of Education, Science and Culture.     

Serum ferritin and transferrin saturation in patients with chronic alcoholic and non-alcoholic liver diseases

Abstract. Objectives. To compare serum ferritin concentration and transferrin saturation in patients with alcoholic and non-alcoholic chronic liver diseases. Design. Concecutive patients with liver diseases. Setting. The department of internal medicine in a teaching hospital. Subjects. Three hundred and twelve patients with different liver diseases concecutively admitted between 1987 and 1992. Interventions. None. Main outcome measures. Fasting serum iron, transferrin and ferritin. Results. Serum ferritin was increased above 200 μg L^?1 in all 18 patients with haemochromatosis (range 310–6500 μg L^?1), in 64 of 111 alcoholics (58%) and in 30 of 137 (22%) with chronic non-alcoholic liver diseases (P < 0.01). Twelve of 111 alcoholics (11%) had serum ferritin above 1000 μg L^?1 compared with one of 137 (0.7%) with chronic non-alcoholic liver diseases. In 13 alcoholics who abstained after admission, serum ferritin decreased from 1483 μg L¹ ± 1134 to 388 μg L^?1 ± 237 (P < 0.001) after 1 1/2 to 6 weeks. The transferrin saturation was increased above 62% in 13 of 18 patients (72%) with haemochromatosis, in 16 of 105 alcoholics (15.2%) and in three of 132 (2.3%) with chronic non-alcoholic liver disease (P < 0.01). Conclusion. Serum ferritin is more frequently elevated in abusing patients with alcoholic liver disease than in patients with other chronic liver diseases such as autoimmune liver diseases and hepatitis C. Because serum ferritin decreases rapidly during abstinence, the measurement of ferritin for the detection of haemochromatosis in patients abusing alcohol should be postponed until the patients are abstaining. Most of the patients with increased serum ferritin have normal transferrin saturation values which can be used to separate them from haemochromatosis.     

Alcoholic Hepatitis in Females

ABSTRACT In the period 1970–1984 alcoholic hepatitis was diagnosed by liver biopsy in 52 females. Thirty-six patients with cirrhosis were generally in a worse clinical and biochemical state than those without cirrhosis. Biochemical tests for liver function showed significant improvement from admission to the time of liver biopsy. At follow-up liver function tests were generally better in patients who had stopped drinking alcohol compared to those who continued to do so. The 5-year survival rate was 82% for females without cirrhosis, and 45% for those with cirrhosis (p < 0.03). Considering the sex-related differences in alcohol abuse in the general population we found no evidence of increased susceptibility to the hepatotoxic effect of alcohol in females.     

缺糖转铁蛋白对酒精性肝病的诊断意义

目的 评价缺糖转铁蛋白（CDT）对酒精性肝病的诊断价值。方法 选择76例酒精性肝病,55例嗜酒者,32例非酒精性肝病和27例健康者,分别检测谷氨酰转肽酶（GGT）等肝功能指标和CDT。结果 酒精性肝病组CDT阳性率为93.4%;CDT诊断酒精性肝病的灵敏度为93.4%,特异性为71.9%,诊断价值高于GGT、丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）。结论 CDT是诊断酒精性肝病较理想的指标。     

Difference in malignancies of chronic liver disease due to non-alcoholic fatty liver disease or hepatitis C in Japanese elderly patients

Aim: Malignancies that include hepatocellular carcinoma often occurred in patients with chronic liver disease. The aim of this retrospective match control study was to assess the cumulative development incidence and predictive factors for total malignancies in elderly Japanese patients with non‐alcoholic hepatic diseases (NAFLD) or hepatitis C virus (HCV). Methods: A total of 1600 NAFLD patients with age of ≥60 years were enrolled, and 1600 HCV patients with age of ≥60 years were selected as control by matching 1:1 with NAFLD group for age, sex, and follow‐up period. The primary goal is the first development of malignancies. Evaluation was performed by the use of the Wilcoxon rank sum test, the Kaplan–Meier method, and Cox proportional hazard model. The mean observation period is 8.2 years in both NAFLD and HCV group, respectively. Results: The number of patients with the development of malignancies was 167 in the NAFLD group and 395 in the HCV group. The 10th development rate of malignancies was 13.9% in the NAFLD group and 28.2% in the HCV group (risk ratio 2.27; P < 0.001). The incident rates of hepatocellular carcinoma in all the malignancies were 6.0% (10/167) in the NAFLD group and 67.6% (267/395) in the HCV group (P < 0.001). The malignancies in the NAFLD group were observed in the following order: gastric cancer 34 cases (20.4%) > colon cancer 31 cases (18.6%) > prostate cancer 21 cases (12.6%). Conclusions: The incident rates of hepatocellular carcinoma in all the malignancies were approximately 6% in the NAFLD group and two‐thirds in the HCV group.     

Alcohol and iron: One glass of red or more?

The consumption of excessive amounts of alcohol affects human iron homeostasis and an association of iron overload and heavy alcohol consumption has been recognized for many years. Both major proteins of iron metabolism, ferritin and transferrin, are affected by alcohol. Increased hepatic iron levels are seen in a high proportion of alcoholic subjects, sometimes causing confusion in diagnosis between alcoholic liver disease and iron-overload disease. The pattern of deposition of this iron in alcoholics, however, differs from that seen in the iron-overload disease haemochromatosis. Excessive alcohol consumption causes transferrin to become carbohydrate deficient, which allows it to be used as an efficient biochemical marker of alcohol abuse. It is concluded that alcohol consumption in moderation is unlikely to have deleterious health consequences.     

Evaluation of the diagnostic utility of carbohydrate-deficient transferrin in chronic alcoholism: Results from Southwest China

Although recent gathered evidence indicates that obtaining the diagnostic value of serum carbohydrate-deficient transferrin might be more useful for identifying alcohol abuse than other widely available biochemical tests; however, its precise value as an indicator of chronic alcoholism is unclear. The main objective is to investigate the diagnostic significance of carbohydrate-deficient transferrin in chronic alcoholism in the Chinese population.In this study, we enrolled (1) 52 physically healthy subjects, (2) 20 patients with nonalcoholic liver disease, and (3) 70 alcoholics. Patients with liver injuries and a history of liver surgery were excluded. Serum gamma-glutamyltransferase, aspartate aminotransferase, alanine aminotransferase, and mean corpuscular volume were determined by standard biochemical assays, and serum carbohydrate-deficient transferrin was estimated in each group using capillary electrophoresis. Subsequently, the diagnostic value of carbohydrate-deficient transferrin (CDT) in chronic alcoholism was determined based on differences between each indicator among the three groups.The CDT level in the alcoholic group was significantly higher than that of the non-alcoholic liver disease and healthy control groups (P < .05). The area under the curve for alcoholism diagnosis was the highest for CDT, at 0.922, whereas those for gamma-glutamyltransferase, aspartate aminotransferase, alanine aminotransferase, and mean corpuscular volume were 0.860, 0.744, 0.615, and 0.754, respectively. When the cutoff value of CDT was set at 1.25%, the sensitivity and specificity were 85.5% and 89.6%, respectively. However, the correlation between CDT and daily alcohol consumption was weak (r = 0.175; P = .16).Compared with the other parameters evaluated, CDT was a better indicator of alcoholism. It should, therefore, be actively promoted in clinical practice. However, the correlation between CDT and daily alcohol consumption needs further evaluation.     

Circulating IgA immune complexes and skin IgA deposits in liver disease relation to liver histopathology

Alcoholic liver disease (ALD) is characterized by elevated serum IgA concentrations, the presence of circulating immune complexes containing IgA, and IgA deposits along sinusoids in the liver. When combined with the presupposed IgA-clearance function of the liver, a causal association between IgA abnormalities and the liver disease in ALD can be suggested. This prompted us to study the presence and concentration of circulating IgA-containing immune complexes (IgA-CIC) in 41 patients with ALD and 41 patients with other nonalcoholic liver diseases having comparable serum IgA levels. We searched for relationships among IgA-CIC and history of alcohol abuse, liver histopathology, and IgA deposits in the liver. Using an anti-IgA inhibition binding assay, 56% of the patients exhibited IgA-CIC in polyethylene glycol precipitate of serum and 38% showed IgA-CIC in whole serum. The prevalence and concentration of IgA-CIC was lowest in cases with nonspecific changes or steatosis in the liver biopsy and highest in cases with hepatitis or cirrhosis (P < 0.01). The occurrence of IgA-CIC was not related to a history of alcohol abuse or to the presence of IgA deposits along hepatic sinusoids (which occurred in 78% of ALD and 20% of non-ALD cases). A skin biopsy was available from 34 patients (19 with ALD and 15 with non-ALD). In 68% of these biopsies, IgA deposits were observed in superficial blood capillaries. The presence of skin IgA deposits was related to that of IgA-CIC detected in whole serum (P < 0.05): there was no significant relationship with liver histopathology, alcohol abuse, or the presence of IgA deposits in the liver. We conclude that the presence of circulating IgA-CIC is directly related to the severity of liver parenchymal damage, irrespective of an alcohol etiology. This conclusion substantiates the pivotal role of the liver in the clearance of circulating IgA, especially of IgA-CIC.Supported in part by the Alcohol Fonds, The Hague, The Netherlands.     

酒精性肝病合并肝炎病毒感染的临床特点分析

目的 探讨酒精性肝病合并肝炎病毒感染的临床特点,评价酒精性肝病与肝炎病毒感染的关系.方法 选择我院2004年1月至2011年5月收治经确诊的271例酒精性肝病患者,对其临床资料及实验室结果进行回顾性分析.结果 271例酒精性肝病中118例(43.5％)肝炎病毒标志物阳性,其中乙型肝炎病毒标志物阳性的101例(37.3％),丙型肝炎病毒标志物阳性的2例(0.7％),戊型肝炎病毒标志物阳性的14例(5.2％),甲型肝炎病毒标志物阳性的1例(0.3％),无肝炎病毒感染的153例(56.5％).肝炎病毒感染阳性组上消化道出血、肝性脑病百分率比较差异有统计学意义(P＜0.05).两组血清肝功能均有不同程度的异常,且阳性组ALT、AST、TBil、GGT明显高于阴性组,差异有统计学意义(P＜0.05).结论 酒精与肝炎病毒对肝脏损伤有协同作用,酒精性肝病合并肝炎病毒感染加重肝脏的损伤.     

Clinical Cases in Hepatitis: Towards improving liver disease management in Australia

Clinical Cases in Hepatitis 2018 was an interactive educational program for Australian physicians (gastroenterologists, hepatologists, and infectious disease specialists) actively involved in the treatment of liver diseases including hepatitis C virus, hepatitis B virus, and non‐alcoholic steatohepatitis. This educational program sponsored by Gilead Sciences took place on October 12–13, 2018, and provided timely, informative case‐based, and practical education to Australian physicians. This report summarizes keynote lectures from international leaders in the field of hepatitis C virus, hepatitis B virus, and non‐alcoholic steatohepatitis and practical clinical case studies designed to inform and educate Australian physicians on managing challenging patients.     

Fulminant hepatitis in patients with chronic liver disease

The changing epidemiology of hepatitis A virus (HAV) in the UK has led to a decline in natural immunity against the virus. It is estimated that in the UK, HAV is responsible for 10%-20% of cases of liver failure, and an overall mortality rate of 0.1%. It is clear that certain factors predispose patients to more severe HAV disease and increased mortality, although the reasons for this have yet to be elucidated. The age at which infection occurs clearly influences the outcome, with the risk of severe hepatitis increasing sharply after the age of 40 years. Intravenous drug users, homosexual men, individuals with an excessive alcohol intake or patients with chronic liver disease are also at increased risk of severe disease. An analysis of data from King's College Hospital was performed to determine the factors that influence the outcome or clinical course of HAV infection in at-risk patients. Data compiled from 1991 to 1998 revealed 187 cases with confirmed HAV, 45 of whom developed severe hepatitis. Outcomes were varied, eight (17.7%) patients developed acute liver failure and two (4.4%) died.     

复方二氯醋酸二异丙胺治疗慢性病毒性肝炎合并酒精性肝损伤的临床疗效观察

观察应用复方二氯醋酸二异丙胺治疗慢性病毒性肝炎合并酒精性肝损伤的临床疗效。选择确诊慢性病毒性肝炎合并酒精性肝损伤58例,随机分成两组。A组（n=30）在常规保肝治疗基础上,加用复方二氯醋酸二异丙胺（0.4-0.8）克溶于生理盐水中静脉滴注,每日一次;B组（n=28）常规保肝治疗,两组均4周为一疗程。两种药物临床总有效率分别为86.7%、64.3%,血清胆红素下降A组较B组明显（P〈0.05）。复方二氯醋酸二异丙胺对改善慢性病毒性肝炎合并酒精性肝损伤症状和降低血清转氨酶有较好的疗效,伴有高胆红素血症患者应用复方二氯醋酸二异丙胺优于常规保肝治疗。