Has mortality related to alcohol decreased in Sweden?

In Sweden sales of alcohol dropped 17% from 1976 to 1982. Similarly, comparison of data from 1979 and 1982 shows that the mortality from cirrhosis of the liver declined appreciably, by 28% in men and 29% in women. During 1979-82 mortality from pancreatitis also declined noticeably, by 30% in men and 36% in women. By contrast, no decrease occurred in mortality from alcoholic psychosis, alcoholism, or alcohol intoxication. The decrease in mortality from cirrhosis of the liver and pancreatitis is probably explained by a decrease in the consumption of alcohol among an important subgroup of high consumers of alcohol. The lack of a decrease in mortality from alcoholic psychosis, alcoholism, and alcohol intoxication may be because such diagnoses are often made in socially deteriorated, more dependent alcoholic subjects who have not been able to reduce their consumption.     

Importance of markers of hepatitis B virus in alcoholic liver disease

To determine the importance of the presence of serological markers of hepatitis B virus infection in patients with alcohol related liver disease we compared cumulative alcohol intake and clinical and histological features in patients with markers of hepatitis B virus infection and in those without. Hepatitis B surface antigen (HBsAg) was detected in five (2%) out of 285 patients studied and antibody to HBsAg (anti-HBs) in 41 (14%); one patient had antibody to hepatitis B core antigen alone. The combined prevalence of markers of hepatitis B virus infection was similar in patients with alcoholic cirrhosis (18%) and precirrhotic liver disease (13%). Two patients positive for HBsAg had histological features of both alcoholic liver disease and chronic active hepatitis, with stainable HBsAg. Patients with anti-HBs were, however, histologically indistinguishable from patients without markers, and the mean cumulative alcohol intake of patients with anti-HBs was similar to or even higher than that of patients with liver disease of comparable severity who had no evidence of previous infection. The presence of markers of hepatitis B virus infection was related to former residence in countries with a high prevalence of the infection and to previous parenteral treatment and blood transfusions. Infection with hepatitis B virus does not enhance the development of chronic liver disease in heavy drinkers, except in the small number who remain positive for HBsAg.     

Psychiatric morbidity in patients with alcoholic liver disease

Seventy one patients with alcoholic liver disease and an equal number with non-alcoholic liver disease were interviewed using the schedule for affective disorders and schizophrenia. Forty seven (66%) of the group with alcoholic liver disease had or had had psychiatric illnesses compared with 23 (32%) of the control group (p less than 0.001). Affective disorder, particularly major depression, neurotic disorders, and antisocial personality, were all more common among the patients with alcoholic liver disease than the controls. No patient had schizophrenia or other forms of psychosis. Among the patients with alcoholic liver disease 11 men (24%) and 14 women (54%) had an affective or a neurotic disorder that had antedated their heavy drinking, and 30 (77%) of those who had had such a problem at any time had symptoms at the time of interview. Abstinence from alcohol is essential for patients with severe alcoholic liver disease. In view of the high prevalence of psychiatric disorders in these patients psychiatric assessment is important to increase the patients' likelihood of complying with such advice.     

达斡尔族酒精性脂肪肝23例临床诊治分析

目的 探讨莫力达瓦达斡尔族自治旗达斡尔族酒精性脂肪肝的临床病情变化、防治及危险因素.方法 参照2010年《酒精性肝病诊疗指南》（中华医学会肝病学分会、脂肪肝和酒精性肝病学组修订）,回顾性分析2012年10月～2013年2月在莫旗人民医院就诊的23例达斡尔族及25例汉族酒精性脂肪肝患者的临床资料,对两民族的饮酒年限、日饮酒量及肝功能结果进行对比分析.结果 两民族患者饮酒年限比较无显著差异,平均日饮酒量达斡尔族患者显著高于汉族患者（P＜0.05）;两民族患者肝功能检查中AST相比较无显著差异;ALT、GGT相比较达斡尔族患者高于汉族患者（P＜0.05）.结论 达斡尔族酒精性脂肪肝患病与该民族长期大量饮酒、肥胖、难戒酒状态有关,且可能存在遗传特征.随着饮酒时间及每日饮酒量的增加,病情有加重趋势.     

27例酒精性肝硬化临床诊治体会

目的分析酗酒和酒精依赖引起酒精性肝硬化的发生、发展过程及诊治、预后情况。方法将2006年1月1日～2009年12月31日收治住院的27例酒精性肝硬化患者作为治疗组,抽签选择同期住院的肝炎后肝硬化（HBV、HCV）患者27例作为对照组。并排除其他原因引起的肝硬化。记录患者的一般情况、饮酒量、饮酒史、临床表现、实验室检查资料、治疗及转归情况。结果治疗组乙醇摄入量80～300克/天,饮酒年限10～40年,以饮用高浓度的白酒为主。治疗组乏力、纳差、肝区疼痛的出现率明显高于对照组,肝大、腹腔积液、合并代谢综合症明显高于对照组。结论酒精性肝硬化患者乏力、纳差、肝区痛、腹胀等症状以及肝大、合并代谢综合征明显高于肝炎后肝硬化组,可能与酒精性肝硬化常伴有不同程度能量代谢异常、合并症较多、以及脂肪在肝脏内大量沉积有关。治疗组中DF值超过32者病情凶险,近期死亡率高。     

ADH2基因多态性与酒精性心肌病关系的研究

目的研究ADH2基因多态性与酒精性心肌病的关系。方法采用前瞻性研究，随机选择56例正常人和64例嗜酒的非酒精性心肌病及非酒精性肝病患者及82例酒精性心肌病患者为研究对象，应用聚合酶链反应限制性片段长度多态性方法检测ADH2基因多态性。结果嗜酒组和酒精性心肌病组ADH2＊1／-k1及ADH2＊1／＊2型频率高于对照组（P〈0．05），而ADH2＊2／＊2型频率低于对照组（P〈0．05）。同时，嗜酒组和酒精性心肌病组ADH2＊1等住基因的频率高于对照组（P〈0.05），而ADH2＊2等位基因的频率低于对照组（P〈0.05）。嗜酒组和酒精性心肌病组ADH2基因型频率无统计学差异，等住基因的频率亦无统计学差异。结论ADH2基因多态性与嗜酒相关。与酒精性心肌病发生的关系未得到证实。     

酒精性肝病大鼠肝脏组织中铁的测定

目的研究铁与酒精性肝病的关系,以进一步探索铁在该病发病机制中的作用.方法采用酒精灌胃法建立酒精性肝病大鼠模型,取血标本检测肝功能,取肝脏标本作HE染色和普鲁氏蓝染色.结果各酒精灌胃大鼠肝组织均有不同程度的脂肪变性和炎症,与对照组相比,差别有显著性意义(均P＜0.05).实验组大鼠肝脏铁染色阳性铁颗粒较对照组明显增多,并与酒精灌胃时间和肝功能损伤程度呈正相关(均P＜0.05).结论铁在酒精性肝病大鼠肝脏沉积明显增多,可能参与酒精性肝病的发生和发展.     

High-density lipoprotein response to alcohol consumption and abstinence as an indicator of liver function in alcoholic patients

A study of 36 alcoholic men admitted to hospital when intoxicated was undertaken to confirm the value of changes in the level of high-density lipoprotein cholesterol (HDL) as an indicator of liver function in patients with chronic alcoholism. In the patients without severe liver disease the HDL level was high after the recent consumption of alcohol and usually dropped by 0.2 mmol/L or more after 1 or 2 weeks of abstinence. In contrast, in the patients with severe alcoholic liver disease the HDL level was initially low and generally remained low after abstinence.     

肝炎病毒感染与酒精性肝硬化关系的研究(附182例酒精性肝病临床病例报告)

目的：研究肝炎病毒感染与酒精性肝硬化的关系。方法：回顾分析182例年龄为25～75岁男性酒精性肝病患者的临床资料。结果：患酒精性肝病患者人数占同年慢性肝病患者的比例呈增高趋势．由1991年的4．2％增至1995年的17．5％及1996年的21．3％。患者饮酒量与其肝硬化的发展密切相关，而且并发肝炎病毒感染者的肝硬化发生率明显高于未并发感染者。结论：中国酒精性肝病患者的发病率逐年增加；并发肝炎病毒感染加速酒精性肝病的发展。     

Ultrasound scanning in the detection of hepatic fibrosis and steatosis

Hepatic steatosis and fibrosis produce abnormal echo patterns on ultrasound scanning, but the potential of ultrasound scanning for diagnosing these conditions in routine clinical practice is uncertain. A prospective comparative study of 85 patients with histologically assessed liver conditions was performed, and specificity was assessed in 76 patients with functional bowel disease who were presumed to have normal livers. Histological examination showed steatosis ranging from mild to severe in 48 patients and fibrosis ranging from increased fibrous tissue to established cirrhosis in 35 patients. Ultrasound scanning accurately identified steatosis, recognising 45 cases (sensitivity 94%) with a specificity of 84%. Fibrosis was less reliably detected (sensitivity 57% and specificity 88%). Of the 50 patients with alcoholic liver disease, 47 (94%) yielded abnormal results on scanning. In the 76 patients with functional bowel disease there was only one false positive result, giving a specificity of 99% in this group. As hepatic steatosis is the earliest change in alcoholic liver disease and seems to be of prognostic importance for the development of cirrhosis, ultrasound scanning provides an effective screening procedure, particularly in the occult alcoholic, who often presents with non-specific gastrointestinal complaints.     

Alcohol consumption and the risk of alcohol related cirrhosis in women

The risks in women of cirrhosis with a likely primary alcohol aetiology were estimated for various levels of alcohol consumption in a case-control study. Data were obtained from 41 women with a first diagnosis of cirrhosis who had no evidence of non-alcohol-related cirrhosis; three matched controls were interviewed for each case. Significant increases in the risk of cirrhosis were detected at levels of consumption between 41 and 60 g daily; above this level a dose-response relation was observed. The risk of cirrhosis did not appear to be influenced by other nutritional factors or history of liver disease or use of hepatotoxic drugs. One per cent of Australian women consume more than 40 g alcohol daily, yet more than 90% of women identified with cirrhosis consumed alcohol at this level. Preventive interventions to reduce alcohol consumption in the small group of women who consume more than 40 g daily have the potential to reduce substantially the incidence of alcohol related cirrhosis.     

Prior alcohol consumption and mortality following acute myocardial infarction

CONTEXT: Studies have found that individuals who consume 1 alcoholic drink every 1 to 2 days have a lower risk of a first acute myocardial infarction (AMI) than abstainers or heavy drinkers, but the effect of prior drinking on mortality after AMI is uncertain. OBJECTIVE: To determine the effect of prior alcohol consumption on long-term mortality among early survivors of AMI. DESIGN AND SETTING: Prospective inception cohort study conducted at 45 US community and tertiary care hospitals between August 1989 and September 1994, with a median follow-up of 3.8 years. PATIENTS: A total of 1913 adults hospitalized with AMI between 1989 and 1994. MAIN OUTCOME MEASURE: All-cause mortality, compared by self-reported average weekly consumption of beer, wine, and liquor during the year prior to AMI. RESULTS: Of the 1913 patients, 896 (47%) abstained from alcohol, 696 (36%) consumed less than 7 alcoholic drinks/wk, and 321 (17%) consumed 7 or more alcoholic drinks/wk. Compared with abstainers, patients who consumed less than 7 drinks/wk had a lower all-cause mortality rate (3.4 vs 6.3 deaths per 100 person-years; hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.43-0.71) as did those who consumed 7 or more drinks/wk (2.4 vs 6.3 deaths per 100 person-years; HR, 0.38; 95% CI, 0.25-0.55; P<.001 for trend). After adjusting for propensity to drink and other potential confounders, increasing alcohol consumption remained predictive of lower mortality for less than 7 drinks/wk, with an adjusted HR of 0.79 (95% CI, 0.60-1.03), and for 7 or more drinks/wk, with an adjusted HR of 0.68 (95% CI, 0.45-1.05; P =.01 for trend). The association was similar for total and cardiovascular mortality, among both men and women, and among different types of alcoholic beverages. CONCLUSION: Self-reported moderate alcohol consumption in the year prior to AMI is associated with reduced mortality following infarction.     

Factors associated with osteonecrosis in the femoral head in chronic alcoholism

While alcohol abuse is a possible etiologic factor in osteonecrosis in the femoral head (ON), the relationship between alcoholic liver dysfunction and ON is uncertain. Among 336 patients with alcoholic liver dysfunction who had radiographic examination of the hip at two hospitals for alcohol abuse treatment in southern Japan, the records for 291 men and 1 woman (mean age, 47.8 years; range, 24 to 72 years) had adequate information available concerning daily and cumulative alcohol intake, duration of intake, serum concentrations of liver enzymes, and platelet count. These variables were investigated for any correlation between the 8 patients with radiographic evidence of ON and the 284 without. Liver biopsy was performed in 223 patients. Except for alanine aminotransferase, liver enzyme concentrations were significantly lower in patients with ON than in those without. Histologically, 2 patients with ON were diagnosed with cirrhosis; 1 with pre-cirrhotic changes; and 2 with fibrosis. These results suggested that ON occurred in the late stages of liver disease when serum enzyme concentrations had returned to normal or were only mildly elevated.     

细胞色素P450Ⅱ E1-基因多态性在酒精性肝病发病中的意义

目的 :探讨细胞色素 P45 0 E1的基因型与酒精性肝病的相关性。方法 :采用 PCR- RFLP分析方法对 1 0 0例酒精性肝病患者 ,1 5 0例非酒精性肝病患者 ,2 5例酗酒无肝病者和 5 0例正常对照者进行 CYP45 0 E1多态性分析。结果 :CYP45 0 El分成 A型为 C1基因野生纯和子 ,B型为( C1 /C2 )基因的杂合子 ,C型为 C2基因的突变型纯合子。酒精性肝病中 A、B、C型分别 3%、93%、4%;酗酒无肝病组 A型为 1 0 0 %;非酒精性肝病中 A、B型分别 74%、2 6%;健康志愿者 A、B型分别 72 %、2 8%。酒精性肝病与酗酒无肝病组、非酒精性肝病及健康志愿者比较 ,有统计学意义。乙肝引起肝癌与酒精相关性肝癌的 A型明显减少 ,而 B型则明显增多 ,有统计学意义。结论 :C2基因与酒精性肝病的发病及与酒精性肝癌的发生有一定的相关性     

Use of a questionnaire in general practice to increase the recognition of patients with excessive alcohol consumption

A self administered questionnaire, the health survey questionnaire, was designed to detect excessive alcohol consumption and mailed to patients who were registered with two general practices. Replies were received from 2572(75%) of 3452 patients. Excessive consumption was taken as 42 units of alcohol per week or more for men and 21 units per week or more for women: 1 unit = approximately 10 g ethanol and is equivalent to a half pint of beer, one glass of wine, or one standard measure of spirits. One hundred and twenty men (11%) and 68 women (5%) were identified by their responses to the questionnaire as excessive drinkers. According to their responses, roughly half of these expressed some concern about their drinking. In the practice where a disease register was kept 18 patients had been recorded as heavy drinkers before the study, and an additional 74 were detected by the questionnaire. Within 12 months after the questionnaire survey three groups of respondents were reviewed: (a) the excessive drinkers, (b) those who indicated concern about drinking but did not exceed the limits for excessive consumption, and (c) a random sample of those who were in neither of these two categories. Patients in these three groups were interviewed in a standard fashion to determine their alcohol consumption. Breath alcohol measurement was also carried out and a blood sample taken for the estimation of mean cell volume, gamma glutamyltranspeptidase activity, and serum aspartate transaminase activity. There were highly significant correlations between estimates of consumption obtained by the questionnaire and those obtained at interview except among the women who were excessive consumers, whose responses to the questionnaire indicated levels of consumption that were much higher than those to which they admitted at interview. Stated weekly consumption at interview that was above the limits set for the study was used as the standard measure for comparing the questionnaire with the other indicators of excessive drinking. The questionnaire had a considerably greater estimated sensitivity in detecting male excessive consumers than any of the blood tests. Among the women it apparently performed less well, although the numbers stating excessive consumption at interview were small. Breath alcohol measurement was positive in only a few of the excessive drinkers. The use of this simple and inexpensive instrument is likely to prove widely acceptable to patients in general practice and should result in a considerable increase in the recognition by general practitioners of patients with excessive alcohol consumption.     

Alcoholic liver disease

Alcohol is a major cause of liver cirrhosis in the Western world and accounts for the majority of cases of liver cirrhosis seen in district general hospitals in the UK. The three most widely recognised forms of alcoholic liver disease are alcoholic fatty liver (steatosis), acute alcoholic hepatitis, and alcoholic cirrhosis. The exact pathogenesis of alcoholic liver injury is still not clear but immune mediated and free radical hepatic injury are thought to be important. There is increasing interest in genetic factors predisposing to hepatic injury in susceptible individuals. Diagnosis is based on accurate history, raised serum markers such as gamma-glutamyltransferase, mean corpuscular volume, and IgA and liver histology when obtainable. Abstinence is the most important aspect of treatment. Newer drugs such as acamprosate and naltrexone are used to reduce alcohol craving. Vitamin supplements and nutrition are vital while corticosteroids have a role in acute alcoholic hepatitis where there is no evidence of gastrointestinal haemorrhage or sepsis. Liver transplantation has excellent results in abstinent patients with end stage liver disease but there are concerns about recidivism after transplant.     

酒精所致精神障碍96例临床分析

目的：探讨酒精所致精神障碍。方法：对酒精所致精神障碍９６例做临床分析。结果：发现患者以男性,体力劳动,低文化程度为主。发病年龄多在３０岁至５０岁间,从初次饮酒至出现精神症状时间平均为１０４７±５２３年。临床类型以酒依赖和酒中毒性幻觉症多见,常伴有脑、心和肝脏损害。年度住院人数呈逐年上升趋势。复发率高。结论：长期较大量饮酒者常致精神障碍及脑、心、肝的损害。     

Trends in alcohol consumption by pregnant women. 1985 through 1988

To examine trends in alcohol consumption among pregnant women, we examined data collected from 21 states participating in the Behavioral Risk Factor Surveillance System for 4 consecutive years: 1985 through 1988. Overall, 429 (25%) of 1712 pregnant women and 19,903 (55%) of 36,057 nonpregnant women 18 to 45 years of age reported using alcohol in the previous month. Pregnant women who used any alcohol reported consuming a median of four drinks per month, whereas nonpregnant women who used any alcohol reported nine. The prevalence of alcohol consumption among pregnant women declined steadily, from 32% in 1985 to 20% in 1988, but the median number of drinks per month for pregnant women who drank did not change. No decline was observed among the less educated or those under the age of 25 years. In 1988, the prevalence of alcohol use among pregnant women remained highest among smokers (37%) and the unmarried (28%). Although the overall consumption of alcohol by pregnant women in the United States appears to be declining, special efforts are needed to reduce alcohol use among pregnant women who are smokers, unmarried, less educated, or younger, women who may already be at high risk of a poor pregnancy outcome.     

酒精戒断综合征患者意外事件危险评估和预防记录表的设计与应用

目的 制定酒精戒断综合征患者意外事件危险评估和防范措施（以下简称危险评估及防范措施）,指导护理人员加强酒精性肝病患者酒精戒断综合征意外事件防范,以保证护理安全.方法 对2009年1月至2011年12月,108例酒精戒断综合征患者发生的意外事件进行分析.根据患者安全管理相关制度制定危险评估及防范措施,应用危险评估及防范措施对酒精性肝病住院患者进行评估,对评估中A＋B部分内容≥2个危险因素的患者实施防范措施.对比实施前后酒精戒断综合征患者意外事件的发生情况,并检验其可行性.结果 应用危险评估及防范措施减少了酒精戒断综合征患者意外事件的发生,增强了护理人员对酒精戒断综合征患者的安全管理意识及工作能力.结论 危险评估及防范措施有较好的临床指导作用.     

Underdiagnosis of alcoholism by residents in an ambulatory medical practice

Alcoholism is a widespread illness which in its early stages can be treated effectively. It is important, therefore, that medical residents be able to diagnose alcoholism prior to end-stage disease and organ damage. To assess the ability of residents to diagnose alcoholism, a survey was conducted of 95 patients from the ambulatory care internal medicine practice of the Johns Hopkins Hospital. The patients' alcohol consumption was measured by a self-report questionnaire, and the patients answered an alcoholism questionnaire, the responses to which have been shown to correlate with alcoholism. The questionnaire contains four questions, one each on cutting down on alcohol consumption, annoyance at criticism of alcohol consumption, guilty feelings about alcohol consumption, and use of alcohol early in the day. The answers to the questionnaire were compared with the residents' diagnoses of alcoholism on the medical record. Alcoholism was diagnosed by the residents in only 11 of the 20 patients (55 percent) who had given three or more yes answers on the alcoholism questionnaire and in only 14 of the 31 patients (45 percent) who had given two or more yes answers. (Yes answers indicate that patients suffer from alcoholism.) The residents' diagnosis of alcoholism correlated with signs of physical damage or dependence. These results demonstrate a moderate underdiagnosis of alcoholism by residents in the ambulatory care setting and suggest that diagnosing alcoholism in early stages of the disease should be made a part of the training curriculum.