Alcoholic liver disease in women

In 1972-1977, 130 patients with alcoholic liver disease (123 men and 7 women) were admitted. A half of the women had occupations which are related with alcohol consumption and a half were housewives. Daily consumption of alcohol in the women was the same as in the men. Duration of excessive drinking was 11.4 years in the women and 17.1 years in the men, but the difference was not statistically significant. Though the difference of the incidence of alcoholic hepatitis in the women (57%) and in the men (27%) was not statistically significant, frequency of ascites was significantly higher in the women (43%) than in the men (7%). Women seem to be more susceptible to severe form of alcoholic liver damage.     

Sex Differences in Alcohol Consumption and Alcohol-Associated Liver Disease

Alcohol-associated liver disease is becoming increasingly prevalent throughout the United States. Previously alcohol-associated liver disease was known to affect men more often than women; however, this gap between the sexes is narrowing. Studies show that women develop liver disease with lesser alcohol exposure and suffer worse disease as compared with men. This review article explores the increasing prevalence of alcohol-associated liver disease in women, reasons for changing patterns in alcohol consumption and liver disease development including obesity and bariatric surgery, proposed mechanisms of sex-specific differences in alcohol metabolism that may account for this discrepancy between men and women, and sex differences in treatment enrollment and response. Studies were identified by performing a literature search of PubMed and Google Scholar and through review of the references in retrieved articles. Search terms included alcohol-associated liver disease, alcoholic hepatitis, alcoholic cirrhosis, sex, gender, female, epidemiology, bariatric surgery, obesity, treatment. Due to the paucity of literature on some of the relevant subject matter and inclusion of landmark studies, no date range was selected. Studies were included if their methods were sufficiently robust and they made a comparison between the sexes that is clinically relevant. Understanding of the changing epidemiology and mechanisms of liver disease development unique to women are paramount in creating appropriate and effective interventions for women who represent a rapidly growing subset of patients with alcohol-associated liver disease.     

Age and Racial/Ethnic Differences in the Prevalence of Reported Symptoms in Human Immunodeficiency Virus-Infected Persons on Antiretroviral Therapy

Few studies have evaluated age and racial/ethnic differences in the prevalence of symptoms in human immunodeficiency virus (HIV)-infected persons. Thus, the objective of this study was to compare the prevalence of gastrointestinal, metabolic, general malaise, neurologic, or other self-reported symptoms by age and race/ethnicity among 1574 HIV-infected women enrolled in the Women's Interagency HIV Study and 955 HIV-infected men who have sex with men (MSM) enrolled in the Multicenter AIDS Cohort Study. All patients had known dates of initiation of highly active antiretroviral therapy. It was observed that women aged 50 years or more were less likely to experience gastrointestinal symptoms (24% vs. 27%; multivariable P = 0.024), but more likely to experience general malaise (47% vs. 37%; multivariable P = 0.004), neurologic (44% vs. 38%; multivariable P = 0.048), or other symptoms (40% vs. 28%; multivariable P < 0.001) compared with women less than 40 years of age. Only neurologic symptoms had a higher prevalence among older MSM (52% vs. 37%; multivariable P = 0.002), largely driven by paresthesias (48% vs. 31%; multivariable P = 0.004), the most common individual symptom reported by men. Caucasian women generally had the highest prevalence of symptoms, and African American women had the lowest prevalence. Few racial/ethnic differences were noted for MSM. Depression and a prior diagnosis of acquired immunodeficiency syndrome were the strongest and most consistent predictors of clinical symptoms in both cohorts. In summary, the prevalence of reported symptoms varies with patient race/ethnicity, age, and modifiable factors, such as depression and HIV disease stage. Clinicians should consider these factors when counseling patients regarding potential adverse effects of antiretrovirals or symptoms associated with HIV disease.     

彩色多普勒对酒精性肝病的诊断价值

目的探讨彩色多普勒对酒精性肝病（ALD）的诊断价值。方法对40例ALD的病人的多普勒图像进行综合分析。结果ALD组固有动脉（PHA）内径明显宽于健康对照组,脉冲多普勒显示血流速度均高于100cm／s;ALD组门脉主干（PV）内径明显宽于健康对照组,血流速度则低于健康对照组。结论通过对40例ALD病人的彩色多普勒图像进行综合性分析,彩色多普勒是诊断ALD的快速、便捷、可靠、经济、无创的方法。     

Hepatitis B antigens and antibodies in asymptomatic carriers and in chronic liver diseases.

88% of asymptomatic hepatitis B surface antigen (HBsAg) carriers and 97% of HBsAg positive patients with chronic hepatitis or non-alcoholic liver cirrhosis showed high titers of antibody to hepatitis B core antigen (anti-HBc). A high titer of anti-HBc, thus suggested to be an indicator of persistent hepatitis B virus infection, was found rarely in seronegative patients with chronic hepatitis, non-alcoholic cirrhosis, or alcoholic liver diseases. It was not revealed in idiopathic portal hypertension or Budd-Chiari syndrome. In asymptomatic HBsAg carriers of 20--29 years of age, hepatitis B e-antigen (HBeAg) was significantly more frequently found in males than in females. There were differences in sex ratio, age, and history of blood transfusion between B type and non-B type of chronic hepatitis and non-alcoholic liver cirrhosis.     

Risk factors for gallstone disease in a hospital-based study

BACKGROUND: We investigated the risk factors for gallstone disease in Taiwan. METHODS: We retrospectively analyzed medical records of patients receiving periodic health examination at China Medical College Hospital from January to December 2000. A detailed history, physical examination, biochemical measurements, and abdominal ultrasonography were done. RESULTS: The 602 men (58.6%) and 426 women (41.4%) had a mean age of 49.2 +/- 12.8 years (range, 18 to 87). The prevalence of gallstone disease was 7.8% in women and 6.5% in men. After controlling for other covariates, multivariate logistic regression analysis showed that with a reference group aged less than 40 years as a comparison, both men and women aged 65 or older were more likely to have gallstone disease. CONCLUSIONS: Age in both sexes and hepatitis C virus infection in women were found to be risk factors for gallstone disease in our study population.     

Associated liver disease in alcoholic pancreatitis

Two studies investigating the association of liver disease with acute and chronic pancreatitis in alcoholics are presented. In a retrospective study of 50 patients, no clinical liver disease was found in 9 patients with acute pancreatitis, while 23 (56%) of 41 patients with chronic pancreatitis had liver disease by clinical criteria. Of this latter group, 8 were confirmed histologically; thus 19% of patients with chronic pancreatitis had biopsy-proven cirrhosis. Fifty alcoholic patients with pancreatitis were prospectively evaluated. All who had clinical evidence of liver disease were biopsied. No cases of liver disease were encountered in the 4 patients with acute pancreatitis. Although 28 (60%) cases of clinically diagnosed liver disease were present in 46 patients with chronic pancreatitis, only 20 of these seemed significant (cirrhosis, alcoholic hepatitis, severe fatty liver), for an incidence of 43%. Thus, clinically significant alcoholic liver disease occurs quite frequently in association with alcoholic pancreatitis. This association is meaningful in more effective management of these patients in general and in preoperative assessment of the risk of surgery in particular.     

40岁以下初发急性心肌梗死的吸烟男性冠状动脉病变特点

目的 观察吸烟对40岁以下初发急性心肌梗死（AMI）的男性患者冠状动脉病变的影响.方法 入选确诊首发急性心肌梗死的40岁以下男性260例,根据吸烟情况分为吸烟组（n=192）和不吸烟组（n=68）,皆排除合并有高血压、高胆固醇及糖尿病等冠心病主要危险因素病例.通过冠状动脉造影分析患者的冠状动脉病变特点.结果 两组平均年龄相近,均以单支病变为主,三支病变较少.吸烟组单支病变比例低于不吸烟组（50.5％ vs.75.0％,P＜0.001）,而双支病变比例高于不吸烟组（29.2％ vs.14.7％,P＜0.05）.吸烟组0支病变和三支病变比例高于不吸烟组（13.0％ vs.7.4％,7.3％ vs.2.9％）,但无统计学意义（P＞0.05）.单支病变亚组中,两组均以左前降支病变为主,右冠状动脉次之,回旋支较少.吸烟组右冠状动脉病变比例高于不吸烟组（21.4％ vs.10.3％,P＜0.05）,不吸烟组左前降支病变明显高于吸烟组（61.0％vs.24.5％,P＜0.001）.双支病变亚组中,包含右冠状动脉病变组合（右冠状动脉＋左前降支及右冠状动脉＋回旋支）比例吸烟患者多见,和不吸烟组比较,均有统计学意义（P＜0.05）.另外,吸烟组冠状动脉瘤样扩张比例明显高于不吸烟组（12.5％ vs.2.9％,P＜0.05）,且吸烟者大多数发生于右冠状动脉（共20例占83％）.吸烟组Gensini积分亦高于不吸烟组（49.5 ±33.9 vs.39.3±26.4,P＜0.05）.结论 不合并其他危险因素的吸烟青年男性AMI患者病变程度重于不合并其他危险因素非吸烟AMI患者;与不吸烟患者比较,其右冠状动脉狭窄病变及冠状动脉瘤样扩张病变尤其右冠状动脉动脉瘤样扩张病变均多见.     

1-14C]Ethanol breath test in alcoholic liver disease

The activity of ethanol metabolising enzymes was assessed in 51 patients with alcoholic and non-alcoholic liver disease using tracer doses of [1-14C]ethanol and measuring 14CO2 excretion in the breath. Alcoholic patients with only fatty infiltration of the liver showed significantly increased activity compared with controls. Comparing alcoholic patients with cirrhosis and a serum albumin greater than 28 g/l, activity in those with a recent history of continued heavy drinking was significantly greater than in patients who had abstained from alcohol. In addition, both groups of alcoholic cirrhosis showed significantly more activity than patients with non-alcoholic cirrhosis. The activities of patients with acute alcoholic or viral hepatitis were normal when their prothrombin times were less than 7 sec prolonged, but were reduced when prolongation exceeded 7 sec. These results demonstrate that in chronic alcoholic liver disease, even with cirrhosis, alcohol can still increase the activity of ethanol oxidising enzymes provided hepatic function remains adequate. However, this response is lost in acute liver damage and in chronic alcoholic disease with severe hepatic dysfunction.     

gamma-Glutamyl transpeptidase activity in liver disease: serum elevation is independent of hepatic GGTP activity

gamma-Glutamyl transpeptidase activity was measured in liver and serum from 110 patients undergoing diagnostic liver biopsy, including patients with alcoholic liver disease, fatty liver not due to alcohol, primary biliary cirrhosis, persistent hepatic disease, chronic active hepatitis and normal livers. Serum gamma-glutamyl transpeptidase was markedly elevated in patients with alcoholic liver disease and primary biliary cirrhosis while mean hepatic gamma-glutamyl transpeptidase activity was significantly increased only in the alcoholic liver disease group. There was considerable overlap of individual enzyme values among the different disease groups. There was no inhibitors or activators of liver gamma-glutamyl transpeptidase in any of these disorders. The increased liver activity was not related to the degree of hepatic fibrosis or cirrhosis. There was no correlation between hepatic and serum gamma-glutamyl transpeptidase activity. Hepatic and serum gamma activities were equally increased in individuals with alcoholic liver disease whether or not they were drinking at the time of the study. The data suggest that increased hepatic gamma-glutamyl transpeptidase activity is neither specific for alcoholic liver disease nor essential for serum GGTP to be elevated.     

酒精性肝病患者同型半胱氨酸与叶酸水平观察

目的探讨酒精性肝病(ALD)患者血浆同型半胱氨酸(Hcy)与叶酸浓度变化及二者与ALD的关系。方法选择轻型酒精性肝病60例,酒精性脂肪肝64例,酒精性肝炎42例,酒精性肝硬化40例,健康人群55例,并测定血浆中Hcy和叶酸含量。结果各酒精性肝病组Hcy和叶酸水平均高于对照组(P<0.05);各酒精性肝病组治疗后Hcy和叶酸水平均低于治疗前(P<0.05);酒精性肝硬化组治疗后Hcy和叶酸水平高于对照组(P<0.05);对照组,轻型酒精性肝病组,酒精性脂肪肝组和酒精性肝炎组Hcy和叶酸存在相关性(r=0.513,P<0.001;r=0.513,P<0.001;r=0.513,P<0.001;r=0.513,P<0.001),但酒精性肝硬化组二者间无相关性(r=0.201,P>0.05)。结论酒精性肝病Hcy和叶酸水平变化可反映肝功能损害程度,对ALD的治疗与预后判断有一定临床意义。     

Autosomal dominant polycystic kidney disease: symptoms and clinical findings

In 259 subjects at risk to have inherited autosomal dominant polycystic kidney disease (PKD), the frequency of symptoms consistent with urinary tract infection, haematuria, back and abdominal pain, hypertension, renal stones, and end-stage renal failure was evaluated. The diagnosis of PKD was made in 140 of these subjects (54 per cent). At the time of the study, 36 per cent of males and 7 per cent of females with PKD were asymptomatic, normotensive, and denied any previous problems. In patients younger than 30 years, 66 per cent of males but only 11 per cent of females were asymptomatic. In female patients, urinary tract infection (69 per cent) and hypertension (61 per cent) were the most frequent clinical manifestations. In contrast, in males with PKD, these problems were present in only 19 per cent and 42 per cent, respectively. Frequency of other clinical manifestations was similar in women and men with PKD. End-stage renal failure was present in 5 per cent of the 81 patients younger than age of 40, in 33 per cent of the 27 patients 40-49 years old, and in 47 per cent of the 32 patients aged 50 years or more. Physical examination was unreliable in estimating kidney size in most patients, particularly in early stages of the disease. Hypertension and symptoms such as haematuria and back pain, but not urinary tract infections, correlated well with renal size measured by radiograms.     

Autosomal Dominant Polycystic Kidney Disease: Symptoms and Clinical Findings

In 259 subjects at risk to have inherited autosomal dominantpolycystic kidney disease (PKD), the frequency of symptoms consistentwith urinary tract infection, haematuria, back and abdominalpain, hypertension, renal stones, and end-stage renal failurewas evaluated. The diagnosis of PKD was made in 140 of thesesubjects (54 per cent). At the time of the study, 36 per centof males and 7 per cent of females with PKD were asymptomatic,normotensive, and denied any previous problems. In patientsyounger than 30 years, 66 per cent of males but only 11 percent of females were asymptomatic. In female patients, urinarytract infection (69 per cent) and hypertension (61 per cent)were the most frequent clinical manifestations. In contrast,in males with PKD, these problems were present in only 19 percent and 42 per cent, respectively. Frequency of other clinicalmanifestations was similar in women and men with PKD. End-stagerenal failure was present in S per cent of the 81 patients youngerthan age of 40, in 33 per cent of the 27 patients 40–49years old, and in 47 per cent of the 32 patients aged 50 yearsor more. Physical examination was unreliable in estimating kidneysize in most patients, particularly in early stages of the disease.Hypertension and symptoms such as haematuria and hack pain,but not urinary tract infections, correlated well with renalsize measured by radiograms.     

Severe course of delirium tremens. Results of treatment and late prognosis

80 patients (P) (68 men and twelve women) with the diagnosis of delirium tremens were retrospectively analyzed and reexamined over a period of ten years (1974 to 1984). Included were only patients who--after failure of oral medication--required intravenous therapy with Chlomethiazol and thereby intensive care treatment. Mean age was 46.2 (26 to 75) years. During the observation period delirium tremens increased in frequency by 11% each year. Nine patients had two, six patients three and two patients four episodes of delirium tremens. In 86.7% delirium tremens occurred with fatty liver and alcoholic hepatitis, epileptic seizures, cirrhosis and hepatic coma, gastrointestinal hemorrhage and pancreatitis. Eight patients (10%) died in hospital at a mean age of 53.2 years. None of the deceased had less than three (on average four) complicating or associated diseases. These were mostly pneumonia, cirrhosis, hepatic coma, and gastrointestinal hemorrhage. The mean duration of intravenous Chlomethiazol therapy was 4.7 (0.25 to 20) days, the applied dose 26.2 (0.8 to 78.6) grams, there being no significant difference between survivors and non-survivors. Of the 72 survivors 62 were invited for follow-up examination after an average of five years. During this period another twelve patients (15%) died of pneumonia, gastrointestinal bleeding, cardiocirculatory failure and accidents. Life expectancy was only 9.3 years. Of 29 patients who came for follow-up, 55% showed clinical evidence of alcohol dependency, 65% had elevated gamma-glutamyl-transferase.(ABSTRACT TRUNCATED AT 250 WORDS)     

Colorectal carcinoma in young females

BACKGROUND: We sought to study the clinicopathologic characteristics of colorectal cancer in young female patients. We also wanted to determine the association of colorectal cancer with anemia in these female patients and, finally, to determine the effect of gender on prognosis in young patients with colorectal cancer. METHODS: We performed a retrospective analysis of all young patients diagnosed with colorectal cancer between 1982 and 1999 in two teaching hospitals in New York City. RESULTS: A total of 3,546 cases of colorectal cancer were diagnosed. Sixty-one (1.63%) of these patients were young patients and 32 (0.85%) were female. Young refers to all patients in the study who were younger than 40 years of age. The clinical presentation and mean age at presentation were very similar in both male and female patients. At presentation, 87.5% of female patients had anemia compared with only 69% of male patients. Males had a statistically significant higher mean hemoglobin level compared with females (12.87 versus 10.29 g) at P = 0.0001. Seventy-nine percent of female patients compared with 86% of male patients presented with left-sided tumors. Fifty-five percent of males presented with late stage disease compared with 68% of females (P = 0.27). Female sex seemed to adversely affect the prognosis, although this did not reach statistical significance (P = 0.08). Stage of disease was associated with worse prognosis and this was independent of sex. Age and hemoglobin were not independent predictors of mortality. CONCLUSION: Colorectal cancer does occur in females of childbearing age who might have a tendency to present with late stage disease as evidence from this study. Young female patients with anemia should be questioned about gastrointestinal symptoms, and colorectal cancer should definitely be in the differential diagnoses. This might conceivably allow for earlier diagnosis and potential for cure in this patient group.     

Sleep apnea: prevalence of risk factors in a general population

People with snoring, excessive daytime somnolence, and nocturnal breath cessation are very likely to have sleep apnea, particularly if they are obese or hypertensive. We collected epidemiologic data to determine the frequency of these findings in an unselected adult population. Respondents in a random digit dialing telephone survey included 685 people (356 women and 329 men, with a mean age of 50 years). Snoring was reported by 37%, gasping by 8%, excessive daytime somnolence by 36%, and hypertension by 28%; all symptoms were more prevalent in respondents older than 50 years. Snoring and gasping were more common in men than in women. Six persons (1%) had all four risk factors, plus a body mass index of one standard deviation above the mean. Eleven respondents (2%) had all four risk factors, but lower weight. We conclude that all risk factors for sleep apnea are more prevalent in persons over the age of 50 years, and that the incidence of sleep apnea in the general population may be 1%.     

Sex hormone changes in chronic liver disease: a matched study of alcoholic versus non-alcoholic liver disease

Men with liver disease are hypogonadal and feminized. European workers consider the liver disease itself to be the major factor but American workers blame alcohol consumption. We studied sexual dysfunction and sex hormones in three matched groups of men; controls (n = 22), those with alcoholic liver disease (n = 21), and those with non-alcoholic liver disease (n = 21). Men with alcoholic liver disease had more sexual dysfunction. Testosterone and androstenedione concentrations were lower and oestradiol and dehydroepiandrosterone sulphate levels were raised in the liver disease groups. The changes were greatest in the alcoholic liver disease group. In this, the first controlled study, liver disease per se appears to cause sexual dysfunction and sex hormone changes but these changes are amplified by ethanol.     

Risk of fatty infiltration or cirrhosis of the liver in relation to ethanol consumption: a case-control study

A case-control study was conducted to investigate the risk of either fatty infiltration of the liver or cirrhosis, in males and females, in relation to varying levels of ethanol consumption. Male and female cases of fatty infiltration of the liver (47 males and 43 females) and male and female cases of cirrhosis (85 males and 66 females) were identified during 1981-1982 as part of a liver biopsy study in 6 teaching hospitals in Toronto. All cases were confirmed by biopsy. Male and female controls (394 males and 225 females) were obtained from 7 different local industries during the same period as part of a study for the early detection of liver disease. Cases and controls were interviewed by a nurse practitioner using a standard questionnaire designed to elicit data on daily and cumulative alcohol consumption. In both males and females, a dose-response effect between increasing levels of both daily and cumulative alcohol consumption and increasing risk of either fatty liver or cirrhosis was demonstrated and was independent of effects of age and duration of consumption. In males, risk for fatty liver was 1.37 (95% CL = 0.47, 4.0) for those consuming 40-59 g absolute alcohol/day compared to males consuming less than 40 g/day, rising to 50 (95% CL = 15.0, 170.7) for males consuming 80 or more g/day. In females, risk for fatty liver appeared at lower levels and was 2.82 (95% CL = 1.02, 7.82) for females consuming 20-59 g/day compared to females consuming less than 20 g/day, rising to 8.53 (95% CL = 2.12, 34.31) for females consuming 60 or more g/day.(ABSTRACT TRUNCATED AT 250 WORDS)     

酒精性肝病患者健康相关生存质量研究

目的研究酒精性肝病患者健康相关生存质量及其与疾病严重程度的关系以及对比酒精性肝病与慢性乙型肝炎患者健康相关生存质量的差别。方法 2010年12月至2011年10月收治的70例男性酒精性肝病患者(非肝硬化组45例,肝硬化组25例),56例男性慢性乙型肝炎患者(非肝硬化组24例,肝硬化组32例)以及42例男性健康对照组受试者参与试验。所有受试者回答SF-36V2(中文版)量表,通过SF-36V2软件计算出:生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能、精神健康共8个维度,以及躯体健康总评和精神健康总评。使用协方差分析对比健康对照组,酒精性肝病非肝硬化组,以及酒精性肝病肝硬化组健康相关生存质量;对比酒精性肝病与慢性乙型肝炎患者健康相关生存质量。结果和健康对照组相比,酒精性肝病患者随着疾病的加重,SF-36V2各维度评分明显降低(P<0.05)。酒精性肝病非肝硬化组患者较慢性乙型肝炎非肝硬化组患者仅生理功能、生理职能、活力、躯体健康总评四项评分轻度受损(P<0.05)。酒精性肝病肝硬化组与慢性乙型肝炎肝硬化组患者SF-36V2各维度评分相似(P>0.05)。结论酒精性肝病患者健康相关生存质量降低,且病情越重,健康相关生存质量越差。酒精性肝病患者健康相关生存质量与慢性乙型肝炎患者相似。     

体检人群脂肪肝患病率及相关知识掌握情况调查及对策

目的了解体检人群脂肪肝患病率及相关知识掌握情况,探讨护理干预对策。方法2007年12月-2008年10月对1530名体检者进行健康体检,统计脂肪肝患病情况,并对患者脂肪肝相关知识进行问卷调查,了解患者对脂肪肝相关知识掌握情况。结果脂肪肝患病率为14．8％（226／1530）,其中男性患病率为18．0％（164／912）,女性患病率为10．0％（62／618）,男女比较,差异具有统计学意义（χ^2=12．24,P〈0．01）;脂肪肝患者中长期大量饮酒史占45．1％（102／226）;对脂肪肝相关知识不了解率在36.3％-62．4％。结论体检人群脂肪肝患病率较高,男性高于女性,主要与大量长期饮酒有关;脂肪肝患者对疾病相关知识缺乏了解,应加强患者相关知识教育。