Alcoholic liver disease with nonalcoholic fatty liver disease and obesity
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摘要:
长期以来,研究人员和临床医生把脂肪性肝病严格区分为酒精性肝病和非酒精性脂肪性肝病。研究酒精性肝病时,忽视了肥胖、糖尿病、代谢综合征等非酒精因素对肝脏疾病的影响,而在研究非酒精性脂肪性肝病时,通常忽略酒精对肝脏的损伤作用。新时期脂肪性肝病的临床及科研需关注酒精及非酒精损肝因素的双重影响,二者常合并存在,共同促进肝病进展。从酒精性肝病临床特征的转变、非酒精性脂肪性肝病合并饮酒的疾病模式以及二者的鉴别诊断等方面对新时期脂肪性肝病的临床特征进行阐述。
Abstract:For a long time, researchers and clinicians have strictly divided fatty liver diseases into alcoholic and non-alcoholic fatty liverdisease. When one was diagnosed as alcoholic liver disease, the effects of non-alcoholic factors, including obesity, diabetes or metabolicsyndrome, on liver diseases have been neglected. Conversely, when the patient was diagnosed as non-alcoholic fatty liver disease, the im-pacts of alcohol drinking are usually ignored. In the new era, physicians and scientific researchers need to pay more attention to the dual fac-tors of alcohol and obesity, which often exist together and affect liver disease progression. This article elaborates on the clinical features of fat-ty liver disease in the new era from the aspects of changes in the clinical features of alcoholic liver disease, disease pattern of nonalcoholicfatty liver disease with drinking, and differential diagnosis of alcoholic and nonalcoholic fatty liver diseases.
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Key words:
- liver diseases, alcoholic /
- non-alcoholic fatty liver disease /
- obesity /
- alcohol
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[1] Nutritional status in cirrhosis. Italian multicentre cooperative pro-ject on nutrition in liver cirrhosis[J]. J Hepatol, 1994, 21 (3) :317-325. [2] CAREGARO L, ALBERINO F, AMODIO P, et al. Malnutritionin alcoholic and virus-related cirrhosis[J]. Am J Clin Nutr, 1996, 63 (4) :602-609. [3] European Association for the Study of the Liver. EASL clinicalpractice guidelines on nutrition in chronic liver disease[J]. JHepatol, 2019, 70 (1) :172-193. [4] National Workshop on Fatty Liver and Alcoholic Liver Disease, Chinese Society of Hepatology, Chinese Medical Association;Fatty Liver Expert Committee, Chinese Medical Doctor Associ-ation. Guidelines of prevention and treatment for alcoholic liverdisease:A 2018 update[J]. J Prac Hepatol, 2018, 21 (2) :170-176. (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].实用肝脏病杂志, 2018, 21 (2) :170-176. [5] SINGAL AK, BATALLER R, AHN J, et al. ACG clinical guide-line:Alcoholic liver disease[J]. Am J Gastroenterol, 2018, 113 (2) :175-194. [6] European Association for the Study of the Liver. EASL clinicalpractice guidelines:Management of alcohol-related liver dis-ease[J]. J Hepatol, 2018, 69 (1) :154-181 [7] FAN JG. Epidemiology of alcoholic and nonalcoholic fatty liverdisease in China[J]. J Gastroenterol Hepatol, 2013, 28 (Sup-pl 1) :11-17 [8] FAN JG, ZHU J, LI XJ, et al. Prevalence of and risk factorsfor fatty liver in a general population of Shanghai, China[J]. JHepatol, 2005, 43 (3) :508-514. [9] BELLENTANI S, SACCOCCIO G, MASUTTI F, et al. Preva-lence of and risk factors for hepatic steatosis in Northern Italy[J]. Ann Intern Med, 2000, 132 (2) :112-117. [10] MEHTA M, SATSANGI S, DUSEJA A, et al. Can alcoholic liv-er disease and nonalcoholic fatty liver disease co-exist[J].J Clin Exp Hepatol, 2017, 7 (2) :121-126. [11] RAYNARD B, BALIAN A, FALLIK D, et al. Risk factors of fi-brosis in alcohol-induced liver disease[J]. Hepatology, 2002, 35 (3) :635-638. [12] STEPANOVA M, RAFIQ N, YOUNOSSI ZM. Components ofmetabolic syndrome are independent predictors of mortality inpatients with chronic liver disease:A population-based study[J]. Gut, 2010, 59 (10) :1410-1415. [13] National Workshop on Fatty Liver and Alcoholic Liver Disease, Chinese Society of Hepatology, Chinese Medical Association;Fatty Liver Expert Committee, Chinese Medical Doctor Associ-ation. Guidelines of prevention and treatment for nonalcoholicfatty liver disease:A 2018 update[J]. J Prac Hepatol, 2018, 21 (2) :177-186. (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.非酒精性脂肪性肝病防治指南 (2018年更新版) [J].实用肝脏病杂志, 2018, 21 (2) :177-186. [14] CHALASANI N, YOUNOSSI Z, LAVINE JE, et al. The diagno-sis and management of nonalcoholic fatty liver disease:Prac-tice guidance from the American Association for the Study ofLiver Diseases[J]. Hepatology, 2018, 67 (1) :328-357. [15] RUHL CE, EVERHART JE. Joint effects of body weight and al-cohol on elevated serum alanine aminotransferase in the Unit-ed States population[J]. Clin Gastroenterol Hepatol, 2005, 3 (12) :1260-1268. [16] AJMERA V, BELT P, WILSON LA, et al. Among patients withnonalcoholic fatty liver disease, modest alcohol use is associ-ated with less improvement in histologic steatosis and steato-hepatitis[J]. Clin Gastroenterol Hepatol, 2018, 169 (9) :1511-1520. [17] CHANG Y, CHO YK, KIM Y, et al. Nonheavy drinking andworsening of non-invasive fibrosis markers in nonalcoholicfatty liver disease:A cohort study[J]. Hepatology, 2019, 69 (1) :64-75. [18] CHANG B, XU MJ, ZHOU Z, et al. Short-or long-termhigh-fat diet feeding plus acute ethanol binge synergisticallyinduce acute liver injury in mice:An important role for CXCL1[J]. Hepatology, 2015, 62 (4) :1070-1085. [19]BERG F, HELENIUS-HIETALA J, PUUKKA P, et al. Bingedrinking and the risk of liver events:A population-based co-hort study[J]. Liver Int, 2017, 37 (9) :1373-1381. [20] LOOMBA R, YANG HI, SU J, et al. Synergism between obe-sity and alcohol in increasing the risk of hepatocellular carcino-ma:A prospective cohort study[J]. Am J Epidemiol, 2013, 177 (4) :333-342. [21] ASCHA MS, HANOUNEH IA, LOPEZ R, et al. The incidenceand risk factors of hepatocellular carcinoma in patients withnonalcoholic steatohepatitis[J]. Hepatology, 2010, 51 (6) :1972-1978. [22] GBD 2016 Alcohol Collaborators. Alcohol use and burden for195 countries and territories, 1990-2016:A systematic analy-sis for the Global Burden of Disease Study 2016[J]. Lancet, 2018, 392 (10152) :1015-1035. [23]BERG F, HELENIUS-HIETALA J, PUUKKA P, et al. Inter-action between alcohol consumption and metabolic syndromein predicting severe liver disease in the general population[J]. Hepatology, 2018, 67 (6) :2141-2149. [24] RATZIU V, GHABRIL M, ROMERO-GOMEZ M, et al. Rec-ommendations for management and treatment of nonalcoholicsteatohepatitis[J]. Transplantation, 2019, 103 (1) :28-38. [25] SOOKOIAN S, PIROLA CJ. How safe is moderate alcoholconsumption in overweight and obese Individuals?[J]. Gas-troenterology, 2016, 150 (8) :1698-1703. [26] AJMERA VH, TERRAULT NA, HARRISON SA. Is moderate al-cohol use in nonalcoholic fatty liver disease good or bad? Acritical review[J]. Hepatology, 2017, 65 (6) :2090-2099. [27] DUNN W, CHALASANI N. Advice regarding alcohol use by in-dividuals with nonalcoholic fatty liver disease:Primum non no-cere[J]. Hepatology, 2019, 69 (1) :9-11. [28] DUNN W, ANGULO P, SANDERSON S, et al. Utility of a newmodel to diagnose an alcohol basis for steatohepatitis[J].Gastroenterology, 2006, 131 (4) :1057-1063. [29] CEROVIC'I, MLADENOVIC'D, JEˇS IC'R, et al. Alcoholic liverdisease/nonalcoholic fatty liver disease index:Distinguishingalcoholic from nonalcoholic fatty liver disease[J]. Eur J Gas-troenterol Hepatol, 2013, 25 (8) :899-904.
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