防治酒精性肝病最有效的措施:戒酒

长期大量饮酒可引起酒精性肝病(alcoholic liverdisease,ALD)。ALD包括轻度酒精性肝损伤(mild al—coholic injury,MAI)、酒精性脂肪肝(alcoholic fattyliver,AFL)、酒精性肝炎(alcoholic hepatitis,AH)和酒精性肝硬化(alcoholic liver cirrhosis,AC)。目前普遍对男性饮酒折合乙醇量>40 g/d,女性>20 g/d,连续5年以上者定为嗜酒者。ALD的严重程度与饮酒量呈正     

CD14 promoter polymorphism in Chinese alcoholic patients with cirrhosis of liver and acute pancreatitis

AIM: To investigate the relationship between genetic polymorphism of the CD14 promoter and the occurrence of alcoholic cirrhosis and alcoholic pancreatitis, and to challenge the conclusion made earlier that the patients with acute alcoholic pancreatitis and patients with alcoholic cirrhosis of liver are two different subpopulations. METHODS: Using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method, we determined the polymorphism of CD14 gene and aldehyde dehydrogenase gene 2 (ALDH 2) in 335 alcoholic patients with different organ complications i.e., cirrhosis of liver (n = 100), acute pancreatitis (n = 100), esophageal cancer (n = 82) and avascular necrosis of hip joint (AVN) (n = 53) and 194 non-alcoholic controls in a Chinese group. RESULTS: The results showed that the carriage of T allele was not different among alcoholic patients with cirrhosis of liver, alcoholic patients with other complication and non-alcoholic controls. On the other hand, the carriage of the C allele was significantly more prevalent for alcoholic pancreatitis than for esophageal cancer (0.79 vs 0.60, P<0.001), alcoholic AVN (0.79 vs 0.65, P<0.025) and nonalcoholic controls (0.79 vs 0.68,P<0.025). Furthermore, when only subjects with ALDH2 1-1 genotype were examined, the C allele frequency was significantly more prevalent for alcoholic pancreatitis than for alcoholic liver cirrhosis (0.82 vs 0.69,P<0.025), esophageal cancer (0.82 vs 0.61,P><0.01), alcoholic AVN (0.82 vs 0.64, P<0.01) and non-alcoholic controls (0.82 vs 0.69, P<0.05). CONCLUSION: The C allele may be associated with some mechanism, which is important in the pathogenesis of alcoholic pancreatitis, and that alcoholic patients with acute pancreatitis and cirrhosis of liver are probably two different subpopulations.     

Pathology of alcoholic liver disease,can it be differentiated from nonalcoholic steatohepatitis?

The liver involvement in alcoholic liver disease(ALD) classically ranges from alcoholic steatosis, alcoholic hepatitis or steatohepatitis, alcoholic cirrhosis and even hepatocellular carcinoma. The more commonly seen histologic features include macrovesicular steatosis, neutrophilic lobular inflammation, ballooning degeneration, Mallory-Denk bodies, portal and pericellular fibrosis. Nonalcoholic steatohepatitis(NASH) is a condition with similar histology in the absence of a history of alcohol intake. Although the distinction is essentially based on presence or absence of a history of significant alcohol intake, certain histologic features favour one or the other diagnosis. This review aims at describing the histologic spectrum of alcoholic liver disease and at highlighting the histologic differences between ALD and NASH.     

酒精性肝病基层诊疗指南(2019年)

正1概述1.1定义酒精性肝病(alcoholic liver disease,ALD)是由于长期大量饮酒导致的肝脏疾病。初期通常表现为单纯性脂肪肝,进而可发展成酒精性肝炎(alcoholic steatohepatitis,ASH)、肝纤维化和肝硬化。严重酗酒时可诱发广泛肝细胞坏死,甚至肝功能衰竭~([1])。     

Development of risky varices in alcoholic cirrhosis with a well-maintained nutritional status

AIM: To compare the nutritional status between alcoholic compensated cirrhotic patients and hepatitis C virus(HCV)-related cirrhotic patients with portal hypertension.METHODS: A total of 21 patients with compensated cirrhosis(14 with HCV-related cirrhosis and seven with alcoholic cirrhosis) who had risky esophageal varices were investigated. In addition to physical variables, including the body mass index, triceps skinfold thickness, and arm-muscle circumference, the nutritional status was also assessed using the levels of pre-albumin(pre-ALB), retinol-binding protein(RBP) and non-protein respiratory quotient(NPRQ) measured with an indirect calorimeter.RESULTS: A general assessment for the nutritional status with physical examinations did not show a significant difference between HCV-related cirrhosis and alcoholic cirrhosis. However, the levels of pre-ALB and RBP in alcoholic compensated cirrhotic patients were significantly higher than those in HCV-related compensated cirrhotic patients. In addition, the frequency of having a normal nutritional status(NPRQ ≥ 0.85 and ALB value 3.5 g/d L) in alcoholic compensated cirrhotic patients was significantly higher than that in HCV-related compensated cirrhotic patients.CONCLUSION: According to our small scale study, alcoholic compensated cirrhotic patients can develop severe portal hypertension even with a relatively well-maintained liver function and nutritional status compared with HCV-related cirrhosis.     

酒精性肝炎的诊断与治疗策略

酒精性肝炎(alcoholic hepatitis,AH)尤其是重症酒精性肝炎(severe alcoholic hepatitis,SAH)一直是肝衰竭常见的、威胁生命的原因之一.患者常有长期大量饮酒史,肝损伤通常为亚急性,经过数周或数月才出现明显的临床表现.基本的治疗包括戒酒、营养支持和抗炎保肝.SAH的糖皮质激素...     

酒精性肝病与血脂代谢相关性分析

目的探讨不同时期酒精性肝病(alcoholic liver disease,ALD)患者血脂代谢的变化。方法比较2008年1月-2013年10月中国医科大学附属第一医院健康体检者及酒精性脂肪肝(alcoholic fatty liver,AFL)、酒精性肝硬化(alcoholic liver cirrhosis,ALC)、慢性病毒性肝炎肝硬化(viral liver cirrhosis,VLC)、ALC合并酒精性肝炎(alcoholic hepatitis,AH)、ALC不合并AH患者的血脂变化。结果与健康体检者相比,AFL患者的TG、TC、LDLC显著升高(P0.05),HDLC显著降低(P0.05)。与AFL患者相比,ALC患者的TG、TC、HDLC、LDLC均显著降低(P0.05)。与VLC患者相比,ALC患者的TG、TC、LDLC显著升高(P0.05),HDLC差异无统计学意义(P0.05)。与不合并AH的ALC患者相比,ALC合并AH患者的HDLC显著降低(P0.05),TG、TC、LDLC差异无统计学意义(P0.05)。结论随着ALD的发生、发展,血脂在AFL中水平明显上升,当发展为ALC时,血脂明显下降;与ALC相比,VLC的血脂下降更明显;合并AH的ALC患者HDLC明显低于不合并AH的ALC患者。     

Etiology and functional status of liver cirrhosis by 31P MR spectroscopy

AIM: To assess the functional status and etiology of liver cirrhosis by quantitative 31P magnetic resonance spectroscopy (MRS). METHODS: A total of 80 patients with liver cirrhosis of different etiology and functional status described by Child-Pugh score were examined and compared to 11 healthy volunteers. MR examination was performed on a 1.5 T imager using a 1H/31P surface coil by the 2D chemical shift imaging technique. Absolute concentrations of phosphomonoesters (PME), phosphodiesters (PDE), inorganic phosphate (Pi) and adenosine triphosphate (ATP) were measured. RESULTS: MRS changes reflected the degree of liver dysfunction in all the patients as well as in individual etiological groups. The most important change was a decrease of PDE. It was possible to distinguish alcoholic, viral and cholestatic etiologies based on MR spectra. Alcoholic and viral etiology differed in PDE (alcoholic, viral, controls: 6.5±2.3, 6.5±3.1, 10.8±2.7 mmol/L, P<0.001) and ATP (alcoholic, viral, controls: 2.9±0.8, 2.8 ±0.9, 3.7±1.0 mmol/L, P<0.01) from the control group. Unlike viral etiology, patients with alcoholic etiology also differed in Pi (alcoholic, controls: 1.2±0.4, 1.6±0.6 mmol/L, P<0.05) from controls. No significant changes were found in patients with cholestatic disease and controls; nevertheless, this group differed from both alcoholic and viral groups (cholestatic, alcoholic, viral: 9.4 ±2.7, 6.5±2.3, 6.5±3.1 mmol/L, P<0.005) in PDE. CONCLUSION: 31P MRS can significantly help in non-invasive separation of different etiological groups leading to liver cirrhosis. In addition, MRS changes reflect functional liver injury.     

酒精性肝病演变过程中肠道菌群结构的变化及其临床意义

目的采用PCR、变性梯度凝胶电泳(DGGE)等方法分析酒精性脂肪肝(alcoholic fatty liver disease,AFLD)、酒精性肝炎(alcoholic hepatitis,AH)、酒精性肝硬化(alcoholic cirrhosis,AC)患者和健康对照组粪便菌群结构的差异性,以探索肠道菌群在酒精性肝病(alcoholic liver disease,ALD)发生和疾病进展中的作用。方法提取AFLD、AH、AC患者和健康对照组粪便DNA,以细菌通用引物PCR扩增粪便DNA样品中全部细菌16S rDNA高变区序列。将扩增产物通过DGGE分离,获得4组人群肠道细菌种属结构图谱,通过聚类图分析细菌种属结构的差异性,提取有差异的条带DNA进行克隆测序,并与GenBank序列比对鉴定差异性菌群。结果 (1)AC、AH患者的肠道菌群多样性明显少于AFLD患者和健康对照组(P0.05),而AFLD患者与健康对照组的肠道菌群多样性差异无统计学意义;(2)AC与其他3组菌群结构差异有统计学意义,AH与AFLD、健康对照组的肠道菌群结构之间存在一定的相似性,而后两者之间的肠道菌群结构无明显区别。(3)ALD患者出现肠道厚壁菌门的减少;当病情严重至AC时,患者肠道革兰阴性专性厌氧非发酵小杆菌及草绿色链球菌数量增多。结论随着ALD发展,肠道菌群多样性逐渐降低,菌群的相似性发生了改变;当病情严重至AC时,患者肠道革兰阴性专性厌氧非发酵小杆菌及草绿色链球菌数量增多。