饮酒量对酒精性肝硬化食管胃静脉曲张患者肝功能及再出血的影响

马佳丽; 何玲玲; 李坪; 蒋煜; 胡居龙; 周玉玲; 梁秀霞; 魏红山

doi:10.3969/j.issn.1001-5256.2019.11.018

饮酒量对酒精性肝硬化食管胃静脉曲张患者肝功能及再出血的影响

DOI: 10.3969/j.issn.1001-5256.2019.11.018

首都医科大学附属北京地坛医院消化内科

基金项目:

首都医科大学附属北京地坛医院青年人才发展基金“萌芽”支持计划项目(DTMY201807)；

详细信息

中图分类号: R575.2
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出版历程
- 收稿日期: 2019-06-28
- 出版日期: 2019-11-20

Influence of alcohol consumption on liver function and rebleeding in alcoholic cirrhotic patients with esophageal and gastric varices

Department of Gastroenterology,Beijing Ditan Hospital,Capital Medical University

Research funding:

摘要

摘要: 目的明确饮酒量对酒精性肝硬化患者肝功能及预后的影响。方法选取首都医科大学附属北京地坛医院消化内科自2008年9月-2018年12月因酒精性肝硬化伴食管胃静脉曲张破裂出血并行内镜下治疗患者211例,男208例,女3例,平均随访时间45（2～110）个月。将患者的饮酒情况与其肝功能指标进行相关性分析,根据患者是否发生食管胃静脉曲张再出血进行分组:早期再出血组、迟发性出血组和无再出血组,比较各组患者的肝功能指标与饮酒情况的差异。符合正态分布的计量资料组间比较采用t检验;非正态分布的计量资料组间比较采用Wilcoxon秩和检验。计数资料组间比较采用χ2检验。Spearman秩相关进行相关性分析。结果饮酒持续时间与肌酐（r=0. 142,P=0. 039）、DBil（r=-0. 137,P=0. 047）呈相关性,每日饮酒量与DBil（r=0. 144,P=0. 037）、前白蛋白（r=-0. 190,P=0. 009）呈相关性,而总饮酒量与肝损伤指标均无任何相关性。早期再出血组和迟发性再出血组患者中WBC（t=-2. 355,P=0. 020）、中性粒细胞（t’=-2. ...
- 肝硬化,酒精性 /
- 饮酒 /
- 食管和胃静脉曲张
Abstract: Objective To investigate the influence of alcohol consumption on liver function and prognosis in alcoholic cirrhotic patients.Methods A total of 211 alcoholic cirrhotic patients with gastroesophageal variceal bleeding who underwent endoscopic treatment in Beijing Ditan Hospital,Capital Medical University,from September to December,2018 were enrolled,and among these patients,there were 208 male and 3 female patients,with a mean follow-up time of 45 months( range 2-110 months). The association of alcohol consumption with liver parameters was analyzed. According to the presence or absence of gastroesophageal variceal rebleeding,the patients were divided into early rebleeding group,delayed rebleeding group,and non-rebleeding group,and the three groups were compared in terms of liver parameters and alcohol consumption. The t-test was used for comparison of normally distributed continuous data between groups,and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The Spearman rank correlation test was used for correlation analysis. Results Duration of drinking was correlated with creatinine( r = 0. 142,P = 0. 039) and direct bilirubin( DBil)( r =-0. 137,P = 0. 047),and daily alcohol consumption was correlated with DBil( r = 0. 144,P = 0. 037) and prealbumin( r =-0. 190,P = 0. 009),while there was no correlation between total alcohol consumption and indicators for liver injury. There were significant differences between the early rebleeding group and the delayed rebleeding group in white blood cell count( WBC)( t =-2. 355,P = 0. 020),neutrophils( t' =-2. 602,P = 0. 010),hemoglobin( t = 2. 247,P = 0. 026),mean corpuscular volume( t =-2. 073,P = 0. 040),alanine aminotransferase( Z =-1. 985,P =0. 047),international normalized ratio( Z =-2. 397,P = 0. 017),spleen thickness( Z =-2. 542,P = 0. 011),Child-Pugh score( t' =-2. 364,P = 0. 020),and Child-Pugh grade( Z =-2. 485,P = 0. 013). The non-rebleeding group had significantly lower WBC ( Z =-2. 276,P = 0. 017) and neutrophils( Z =-2. 375,P = 0. 018) than the rebleeding group,and the early and delayed rebleeding groups had a significantly shorter duration of drinking than the non-rebleeding group( Z =-2. 522,P = 0. 012). The logistic regression analysis showed that neutrophils was a risk factor for variceal rebleeding( odds ratio = 1. 152,95% confidence interval: 1. 017-1. 300,P =0. 026). Conclusion No dose-response relationship is found between alcohol consumption and liver injury in this study,and alcohol consumption may not have a marked effect on variceal rebleeding.
- liver cirrhosis,alcoholic /
- alcohol drinking /
- esophageal and gastric varices

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参考文献(15)

[1] National Workshop on Fatty Liver and Alcoholic Liver Disease,Chinese Society of Hepatology,Chinese Medical Association;Fatty Liver Expert Committee,Chinese Medical Doctor Association. Guidelines of prevention and treatment for alcoholic liver disease:A 2018 update[J]. J Clin Hepatol,2018,34(5):939-946.(in Chinese)中华医学会肝病学分会脂肪肝和酒精性肝病学组，中国医师协会脂肪性肝病专家委员会．酒精性肝病防治指南(2018年更新版)[J]．临床肝胆病杂志，2018,34(5):939-946.

[2] KAMPER-JøRGENSEN M,GRøNBAEK M,TOLSTRUP J,et al. Alcohol and cirrhosis:Dose—response or threshold effect?[J]J Hepatol,2004,41(1):25-30.

[3] SHEN Z,LI YM,YU CH,et al. Risk factors for alcohol-related liver injury in the island population of China:A populationbased case-control study[J]. World J Gastroenterol,2008,14(14):2255-2261.

[4] BECKER U,DEIS A,SøRENSEN TI,et al. Prediction of risk of liver disease by alcohol intake,sex,and age:aprospective population study[J]. Hepatology,1996,23(5):1025-1029.

[5] de FRANCHIS R,BAVENO VI FACULTY. Expanding consensus in portal hypertension:Report of the Baveno VI consensus workshop:Satratifying risk and individualizing care for portal hypertension[J]. J Hepatol,2015,63(3):743-752.

[6] FLISER D. The kidneys and old age[J]. Dtsch Med Wochenschr,2008,133(37):1835-1838.

[7] MARTIN JE,SHEAFF MT. Renal ageing[J]. J Pathol,2007,211(2):198-205.

[8] BODE JC,KRUSE G,MEXAS P,et al. Alcoholic fatty liver,alcoholic hepatitis and alcoholic cirrhosis. Drinking behavior and incidence of clinical,clinico-chemical and histological findings in 282 patients[J]. Dtsch Med Wochenschr,1984,109(40):1516-1521.

[9] JEPSEN P,OTT P,ANDERSEN PK,et al. The clinical course of alcoholic cirrhosis:effects of hepatic metabolic capacity,alcohol consumption, and hyponatremia-a historical cohort study[J]. BMC Res Notes,2012,5:509.

[10] CORRAO G,BAGNARDI V,ZAMBON A,et al. A meta-analysis of alcohol consumption and the risk of 15 diseases[J].Prev Med,2004,38(5):613-619.

[11] XIN SJ,ZHANG LX,ZHU CL,et al. Correlation of clinical features with pathology in chronic viral hepatitis[J]. Chin J Exp Clin Virol,2003,17(1):88-90.(in Chinese)辛绍杰，张玲霞，朱传琳，等．慢性病毒性肝炎临床与病理的相关性研究[J]．中华实验和临床病毒学杂志，2003,17(1):88-90.

[12] ZHANG J,DU X,ZHOU Z,et al. Spleen thickness can predict significant liver pathology in patients with chronic hepatitis B with persistently normal alanine aminotransferase or minimally raised alanine aminotransferase:A retrospective study[J].J Int Med Res,2019,47(1):122-132.

[13] DAI GY,LIU Z,ZENG F,et al. Splenic thickness combined with routine clinical markers predicts esophageal varices in patients with liver cirrhosis[J]. J South Med Univ,2017,37(10):1375-1381.(in Chinese)戴戈扬，刘志，曾凡，等．脾厚径联合常规临床指标有效预测肝硬化食管静脉曲张[J]．南方医科大学学报，2017,37(10):1375-1381.

[14] SPIELMANN AL,DELONG DM,KLIEWER MA. Sonographic evaluation of spleen size in tall healthy athletes[J]. AJR Am J Roentgenol,2005,184(1):45-49.

[15] CHOW KU,LUXEMBOURG B,SEIFRIED E,et al. Spleen size is significantly influenced by body height and sex:Establishment of normal values for spleen size at US with a cohort of1200 healthy individuals[J]. Radiology,2016,279(1):306-313.

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