浙江省酒精性肝病流行病学调查概况

目的 了解浙江省酒精性肝病的基本情况。 方法 对浙江省酒精性肝病行作全面流行病学调查,按照代表性及经济有效的原则,分层按比例多阶段整群抽样后,行问卷调查和作肝功能、乙型肝炎、丙型肝炎标志物检测及肝脏B超检查。 结果 有效问卷18237份,男性12042人,女性6195人,平均年龄(38.8±13.3)岁,平均日酒精摄入量为(17.7±27.2)g。酒精性肝病患病率为4.34％,酒精性肝硬化患病率为0.68％,酒精性脂肪肝患病率为0.94％,酒精性肝炎患病率为1.51％,酒精所致其它肝脏损害为1.21％。结论 浙江省酒精性肝病患病率为4.34％,值得有关部门对酒精相关性疾病引起重视。     

云南元江少数民族酒精性肝病流行病学调查

目的了解云南元江县四个民族饮酒与酒精性肝病的关系。方法采用随机整群抽样法,对调查人群（年龄≥15岁）进行问卷调查、体格检查、腹部超声检查和血液生化分析。结果四个民族的1690份有效问卷中：①平均饮酒年限比较：哈尼族、傣族〉汉族〉彝族;②肥胖率汉族最高,哈尼族次之,彝族最低（P〈0．001）,高血压患病率的比较无差异（P〉0．05）;⑧饮酒易引起血小板（PLT）和平均红细胞体积（MCV）升高,但PLT升高的阳性率比较无差异（P〉0．05）;④肝脏血生化检查中,AST和GGT升高,而ALT、ALP、TG的影响无差异;共检出ALD84例（4．97％）。ALD的患病率分别为哈尼族6．84％、彝族4．90％、傣族4．72％、汉族4．48％。结论云南元江县少数民族平均饮酒年限高于汉族,更易患ALD,其中彝族对酒精耐受力最低,敏感性最高;肥胖是ALD的危险因素之一;常年饮酒能使PLT、AST、GGT和MCV升高。ALD的发生与肥胖、种族、饮酒年限密切相关。     

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。     

辽宁省部分城市酒精性肝病流行现状调查

目的探讨辽宁省居民酒精性肝病的流行现状及特点。方法采用分层随机抽样法,对调查人群进行问卷调查,再按调查人群的35%抽样进行相关体格检查及生化检查。结果共调查18020人,抽样调查6598人,其中有长期饮酒者1708人(26.98%);有长期饮酒者(38.33%对5.64%)及周平均饮酒量(223.27±258.88g/w对114.12±199.85g/w,P=0.042)均为男性多于女性;男性饮酒人群的平均年龄大于女性(41.14±9.56岁对36.48±10.21岁,P=0.002),多集中于30～49岁年龄段;男性饮酒的起始年龄早于女性(23.26±5.38岁对25.38±5.20岁);共检出ALD450例(6.8%)。结论辽宁省7岁以上居民中超过1/4的人群有饮酒习惯,而ALD的患病率为6.1%,其中AFL或轻微肝损伤、AH及ALC的患病率为4.29%、2.18%及0.35%。ALD的发生与年龄、性别及饮酒的行为方式密切相关。     

上海市成人饮酒与代谢综合征关系的流行病学调查

目的　通过流行病学调查 ,探讨饮酒与代谢综合征的关系。方法　随机多级分层整群抽查上海市成年居民 ,内容涉及问卷咨询、体检、葡萄糖耐量试验和血脂全套。结果　 42 0 5例成人完成调查 ,年龄 (5 3 .3± 14 .9)岁 ,男女之比为 1∶1.5 5 ,其中有饮酒习惯者 44 8名 (10 .65 % ) ,男性 40 5例 ,女性 43例 ,男性饮酒率显著高于女性 (2 4.5 3 %对 1.72 % ,P <0 .0 0 0 1)。饮酒组、过量饮酒组腹型肥胖、糖代谢异常、低HDL C血症患病率显著低于相应对照组 ,而高三酰甘油(TG)血症、高血压病患病率则显著高于相应对照组 ,代谢综合征患病率在各组之间差异均无显著性。然而 ,空腹血糖水平和体重指数改变与上述结果并不平行。结论　饮酒对多元代谢紊乱影响复杂 ,一方面饮酒可升高血压和TG ,另一方面又可降低腹型肥胖、糖代谢异常以及低HDL C血症患病率。     

酒精性肝病的危险因素分析

目的　明确ALD患病率与酒精摄入的量、饮酒的方式习惯、种类及肥胖等的关系。方法　对西安城乡 4115名各种不同职业人群进行整群随机抽样调查及流行病学资料分析。每一调查对象均经调查员上门按统一要求详细询问其饮酒的种类、品牌、度数、时间、频度、方式及饮酒后不良事件的发生次数等 ,必要时还询问其家人 ,以便能更准确的估计其酒精摄入的量。所有饮酒人群均经B超检查 ,并抽取外周血查肝功 ,HBsAg、抗HCV。结果　①每日饮酒精≥ 40g ,持续饮用 5年以上 ,ALD患病率明显增加 ,最高的OR值出现在日酒精消耗量≥ 160g时 ,此时ALD患病率高达 18 7%。而每日饮酒精 <2 0g ,饮酒时间 <5年时 ,无ALD发生。②空腹饮酒者各种酒类的日均消耗量均大于只在进餐时饮酒者 ,空腹单纯饮用白酒和多种酒混合饮用患病率最高 ,分别达18 9%和 15 4%。单纯饮用啤酒等有色酒者ALD发生率较低。③BMI≥ 2 5的 2 0 3例日均酒精消耗量低于BMI <2 5的人群 ,患病率11 5 % ,明显高于人群患病率 6 5 %。结论　日均酒精消耗量 <2 0g ,短于 5年是发生ALD的相对安全域值。日均酒精消耗量 >40g ,>5年则ALD的发病率明显增加 ;空腹饮用白酒和混合饮用多种酒类 ,ALD患病率较高。肥胖者饮酒 ,可增加ALD各阶段发病的危险     

酒精性肝病的流行病学

国际疾病分类第9次修订版(ICD9)将与酒精相关的死亡原因分为慢性肝病和肝硬化、酒精依赖综合征、酒精性精神病、酒精中毒、酒精滥用、酒精性心肌病、酒精性胃炎和酒精性多发性神经病等。酒精滥用和酒精依赖已成为当今世界日益严重的公共卫生问题。酒精性肝病(alcoholic liver dis-ease,ALD)是指由于过量摄入酒精而导致的肝脏损害等一系列病变,根据中华医学会肝脏病学分会提出的ALD病理诊断标准,可分为轻型ALD、酒精性脂肪肝、酒精性肝炎、酒精性肝纤维化和酒精性肝硬化5种类型。     

新疆少数民族饮酒与酒精性脂肪肝关系的调查

于2003年3月8月，对新疆伊犁地区汉族、维吾尔族、哈萨克族和锡伯族等3个少数民族比较集中的农牧区进行了饮酒与酒精性脂肪肝的调查，现将结果报道如下。     

非酒精性脂肪性肝病患者血脂变化的流行病学调查

目的探讨非酒精性脂肪性肝病(NAFLD)患者血脂变化及其与脂肪肝程度的关系。方法回顾性分析我院门诊就诊的NAFLD患者638例,检测肝功能、血脂、血糖、胰岛素抵抗指数(HOMA-IR)及肝脏CT表现。结果 NAFLD患者TG为2.14±1.62mmol/L,TC为5.19±1.02mmol/L,LDL-C为2.71±0.74mmol/L,HDL-C为1.18±0.26mmol/L,APOA1为1.15±0.26mg/L,APOB为0.96±0.25mg/L,LP(α)为252.6±192.7mg/L,non-HDL-C为4.01±0.82 mmol/L,FBG为5.94±1.04 mmol/L,和HOMA-IR为3.54±2.52;血脂以TG升高为主,FBG、HOMA-IR、TC、APO-B、NON-HDL-C均随脂肪肝程度加重而升高(P<0.05);不同程度脂肪肝患者HDL-C、LDL-C、APO-A1和TG未发现明显统计学差异(P>0.05);患者ALT与脂肪肝程度、BMI和HOMA-IR呈正相关,而与空腹血糖(FBG)和血脂无明显统计学相关(P>0.05)。结论 NAFLD患者血脂异常以TG升高为主,NAFLD患者随脂肪肝程度的加重,TC、APO-B、NON-HDL-C升高。     

Epidemiology of alcoholic liver disease

Alcohol is one of the main causes of end-stage liver disease worldwide, and alcoholic liver disease is the second most common reason for liver transplantation in the United States. Beginning in the 1970s, there was a gradual decline in alcoholic cirrhosis-related mortality in many countries. However, in the past few years, alcoholic liver disease mortality rates in several countries have stabilized or started to increase. There are significant ethnic and gender differences in alcoholic cirrhosis-related mortality rates. Furthermore, alcohol use increases the risk for liver disease in those infected with hepatitis C. A better understanding of the epidemiology of alcoholic liver disease will allow for improved diagnosis and management of this common problem.     

Epidemiology of alcoholic liver disease

Although mortality from alcoholic liver disease has declined in some Western countries in recent years, elsewhere it is increasing and overall it remains a major health problem. Deaths are predominantly seen in patients with alcoholic hepatitis or cirrhosis, and when they occur in patients with fatty liver are usually unrelated to liver disease. Progression to cirrhosis is correlated with the severity of fatty liver and particularly with the presence of alcoholic hepatitis. Mortality from cirrhosis is strongly correlated with per capita alcohol consumption. The decline in cirrhosis mortality rates seen recently is related in part to decreases in per capita consumption, but probably also to the growth of self-help organizations which facilitate abstinence from alcohol. Recent studies suggest there is not an invariable dose-response relationship between alcohol intake and the severity of liver disease and that alcohol has a permissive effect which allows other aetiological factors to operate. Factors that influence susceptibility to alcoholic liver disease include gender (women develop alcoholic cirrhosis more readily than men), concomitant hepatitis C infection and possibly hepatitis B infection. It is uncertain whether HLA status or immune mechanisms are implicated. The systematic use of screening tests for hazardous consumption combined with early intervention therapies offers a good prospect of reducing morbidity and mortality from alcoholic liver disease.     

Epidemiology of autoimmune liver disease

Primary biliary cirrhosis (PBC), autoimmune hepatitis (AIH) and primary sclerosing cholangitis (PSC) are chronic liver diseases that likely have an autoimmune basis to their pathogenesis. Although significant strides have been made in the clinical management of these conditions, their pathogenesis remains obscure. Understanding of various epidemiological factors may shed light on predisposing or causative factors for these diseases. Most is known about the epidemiology of PBC, with only minimal information on that of PSC and AIH. In this review, the current data on the epidemiology of PBC, AIH and PSC are summarized and suggestions are made for future work in this important area.     

Epidemiology of alcoholic liver disease

Although there exists a relationship between alcohol consumption and alcoholic liver disease at both the aggregate and individual levels, it is also well established that less than one-third of alcoholics or heavy drinkers develop serious alcohol-related liver damage. A number of factors have been proposed to account for this susceptibility. Evidence supporting the direct dose-response relationship and the role of genetic and environmental factors in influencing vulnerability are reviewed. To date, no consistent evidence attests to the significance of any one factor in the susceptibility to developing alcoholic liver disease.     

内毒素与酒精性肝病

酒精 (乙醇 )对肝细胞有直接毒性作用 ,其机制涉及乙醇的代谢产物乙醛的毒性、还原型辅酶Ⅰ /辅酶Ⅰ (ＮＡＤＨ/ＮＡＤ )比值增高所致代谢紊乱、氧缺乏、氧应激和自由基的损害等多个方面。近年来 ,许多学者认为肠源性内毒毒血症及其对库普弗细胞的激活可能是乙醇一系列肝毒性作     

Covid-19 and alcohol associated liver disease

The COVID-19 pandemic is having substantial impacts on the health status of individuals with alcohol use disorder (AUD) and alcohol-associated liver disease (ALD). AUD and ALD have both been impacted throughout the pandemic, with increases in alcohol use during the early stages of the pandemic, reduced access to treatment during the mid-pandemic, and challenges in managing the downstream effects in the post-COVID era. This review will focus on how the COVID-19 pandemic has impacted AUD and ALD epidemiology and access to treatment, and will discuss to address this rising AUD and ALD disease burden.     

Epidemiology and natural history of primary nonalcoholic fatty liver disease

The clinical impact of nonalcoholic fatty liver disease depends on its prevalence and natural history. The prevalence in the adult population is estimated to be about 23% and is on the increase. Thus, it has become the most common cause of persistent elevated liver enzymes, chronic liver disease, and cryptogenic cirrhosis in developed countries. The increasing prevalence of nonalcoholic fatty liver disease, which is approaching epidemic proportions, is parallel to that of other disorders associated with insulin resistance, especially obesity and type 2 diabetes mellitus. This entity occurs in men and women equally and in all age groups. The natural history is poorly defined mainly due to the scarcity of histologic follow-up studies. Although steatosis alone has a more benign clinical course, steatohepatitis is a progressive fibrotic disease, in which cirrhosis and liver-related death occur in a similar way to other causes of chronic liver diseases. Progression seems to be mainly dependent on the severity of histological damage at diagnosis, but age older than 40 years, obesity, and type 2 diabetes have also been associated with an increased risk of liver fibrosis and progression to cirrhosis.     

非酒精性脂肪性肝病的流行病学与自然史

非洒精性脂肪性肝病(NAFLD)发病率不断攀高且起病渐趋低龄化,现已成为发达国家和地区第一大肝病,在我国亦有望成为慢性肝病的首要病因.     

Nonalcoholic fatty liver disease and aging: Epidemiology to management

Nonalcoholic fatty liver disease(NAFLD) is common in the elderly, in whom it carries a more substantial burden of hepatic(nonalcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma) and extra-hepatic manifestations and complications(cardiovascular disease, extrahepatic neoplasms) than in younger age groups. Therefore, proper identification and management of this condition is a major task for clinical geriatricians and geriatric hepatologists. In this paper, the epidemiology and pathophysiology of this condition are reviewed, and a full discussion of the link between NAFLD and the aspects that are peculiar to elderly individuals is provided; these aspects include frailty, multimorbidity, polypharmacy and dementia. The proper treatment strategy will have to consider the peculiarities of geriatric patients, so a multidisciplinary approach is mandatory. Non-pharmacological treatment(diet and physical exercise) has to be tailored individually considering the physical limitations of most elderly people and the need for an adequate caloric supply. Similarly, the choice of drug treatment must carefully balance the benefits and risks in terms of adverse events and pharmacological interactions in the common context of both multiple health conditions and polypharmacy. In conclusion, further epidemiological and pathophysiological insight is warranted. More accurate understanding of the molecular mechanisms of geriatric NAFLD will help in identifying the most appropriate diagnostic and therapeutic approach for individual elderly patients.