Alcohol use disorders affect millions of individuals worldwide.Alcohol consumption is directly associated with liver disease mortality and accounts for elevated social and economic costs.Alcoholic liver disease(ALD) m...Alcohol use disorders affect millions of individuals worldwide.Alcohol consumption is directly associated with liver disease mortality and accounts for elevated social and economic costs.Alcoholic liver disease(ALD) may take the form of acute involvement(alcoholic hepatitis)or chronic liver disease(steatosis,steatohepatitis,fibrosis and cirrhosis).The severity and prognosis of alcohol-induced liver disease depends on the amount,pattern and duration of alcohol consumption,as well as on the presence of liver inflammation,diet,nutritional status and genetic predisposition of an individual.While steatosis is an almost completely benign disease,liver cirrhosis is associated with marked morbidity,mortal-ity and life expectancy shortening.The median survival of patients with advanced cirrhosis is 1-2 years.Se-vere acute alcoholic hepatitis(AH)is associated with mortality as high as 50%.It has been managed with corticoids,pentoxifylline and enteral nutrition,although evidence based data are still conflicting.Some author suggest that pentoxifylline could be a better first-line treatment in patients with severe AH.Absolute abstinence is a basic condition for any treatment of acute or chronic ALD,the other therapeutical procedure being of a supportive nature and questionable significance.Acamprosate appears to be an effective treatment strategy for supporting continuous abstinence in alco-hol dependent patients.Patients with advanced liver cirrhosis who demonstrably abstain can be considered for liver transplantation,which leads to a markedly pro-longed life expectancy.The crucial step in ALD preven-tion is in the prevention of alcohol abuse,whereas the prevention of liver injury in active alcohol abusers is not clinically applicable.展开更多
目的观察丁二磺酸腺苷蛋氨酸联合复方甘草酸苷治疗酒精性肝硬化的疗效及骨钙素(BGP)水平的影响。方法选取该院收治酒精性肝硬化患者102例,随机分为对照组51例与观察组51例。对照组给予复方甘草酸苷注射液60 m L,静滴,1次/天。观察组在...目的观察丁二磺酸腺苷蛋氨酸联合复方甘草酸苷治疗酒精性肝硬化的疗效及骨钙素(BGP)水平的影响。方法选取该院收治酒精性肝硬化患者102例,随机分为对照组51例与观察组51例。对照组给予复方甘草酸苷注射液60 m L,静滴,1次/天。观察组在对照组基础上予丁二磺酸腺苷蛋氨酸(思美泰)500 mg,口服,2次/天。两组连续治疗4周。比较两组肝功能、肝纤维化水平及临床疗效。检测两组血清BGP水平。结果治疗后,观察组患者血清中丙氨酸氨基转氨酶(ALT)、总胆红素(TBi L)、Ⅲ型前胶原氨基端肽(PCⅢ)、Ⅳ胶原(CⅣ)、层黏连蛋白(LN)和透明质酸(HA)明显低于对照组,白蛋白(ALB)明显高于对照组(P<0.05)。观察组总有效率为92.16%,对照组为74.51%,观察组显著高于对照组(P<0.05)。治疗后4周和8周,观察组患者血清中BGP水平显著高于对照组,比较差异有统计学意义(P<0.01)。结论丁二磺酸腺苷蛋氨酸联合复方甘草酸苷治疗酒精性肝硬化的疗效显著,上调患者血清中BGP水平可能与其治疗效果联系密切。展开更多
目的:探讨乙型肝炎病毒(hepatitis B virus,HBV)感染合并酒精性肝病(alcoholic liver disease,ALD)失代偿期肝硬化患者的临床特点,评价HBV感染与酒精性肝病之间的关系,分析其预后,为临床治疗提供参考.方法:采用病例对照研究,严格按照病...目的:探讨乙型肝炎病毒(hepatitis B virus,HBV)感染合并酒精性肝病(alcoholic liver disease,ALD)失代偿期肝硬化患者的临床特点,评价HBV感染与酒精性肝病之间的关系,分析其预后,为临床治疗提供参考.方法:采用病例对照研究,严格按照病例和对照的纳入和排除标准,选取2010-01/2015-10在华北理工大学附属医院住院的HBV感染合并ALD的肝硬化失代偿期患者86例作为观察组,选择同期住院的单纯HBV感染肝硬化失代偿期患者94例(乙型肝炎组)、单纯ALD的失代偿期肝硬化患者92例(酒精肝组)作为对照组.对3组患者的临床资料和实验室结果进行回顾性分析,评价3组的治疗效果,分析HBV感染与ALD之间的关系.结果:观察组在乏力、腹胀、食欲不振、黄疸等常见临床表现较乙型肝炎组、酒精肝组相比(P>0.05),差异没有统计学意义,在上消化道出血、肝性脑病、腹水并发症方面差异具有统计学意义(P<0.01);3组患者肝功能指标谷丙转氨酶、谷草转氨酶、胆碱脂酶、总胆红素均有不同程度的异常,且观察组较乙型肝炎组、酒精肝组相比明显加重,差异具有统计学意义(P<0.05);3组患者病理指标,观察组炎症程度较乙型肝炎组、酒精肝组相比,差异具有统计学意义(P<0.05).结论:HBV感染合并ALD对肝脏损伤具有协同作用,会加重肝功能损伤,促使病情恶化,降低治疗效果.展开更多
AIM:To test if inflammation also interferes with liver stiffness (LS) assessment in alcoholic liver disease (ALD) and to provide a clinical algorithm for reliable fibrosis assessment in ALD by FibroScan (FS).METHODS...AIM:To test if inflammation also interferes with liver stiffness (LS) assessment in alcoholic liver disease (ALD) and to provide a clinical algorithm for reliable fibrosis assessment in ALD by FibroScan (FS).METHODS:We first performed sequential LS analysis before and after normalization of serum transaminases in a learning cohort of 50 patients with ALD admitted for alcohol detoxification. LS decreased in almost all patients within a mean observation interval of 5.3 d. Six patients (12%) would have been misdiagnosed with F3and F4 fibrosis but LS decreased below critical cut-off values of 8 and 12.5 kPa after normalization of trans-aminases. RESULTS:Of the serum transaminases,the decrease in LS correlated best with the decrease in glutamic oxaloacetic transaminase (GOT). No significant chang-es in LS were observed below GOT levels of 100 U/L. After establishing the association between LS and GOT levels,we applied the rule of GOT < 100 U/L for reliable LS assessment in a second validation cohort of 101 patients with histologically confi rmed ALD. By ex-cluding those patients with GOT > 100 U/L at the time of LS assessment from this cohort,the area under the receiver operating characteristic (AUROC) for cirrhosis detection by FS improved from 0.921 to 0.945 while specificity increased from 80% to 90% at a sensitivity of 96%. A similar AUROC could be obtained for lower F3 fibrosis stage if LS measurements were restricted to patients with GOT < 50 U/L. Histological grading of inflammation did not further improve the diagnostic accuracy of LS.CONCLUSION:Coexisting steatohepatitis markedly increases LS in patients with ALD independent of fibrosis stage. Postponing cirrhosis assessment by FS during alcohol withdrawal until GOT decreases to < 100 U/mL signif icantly improves the diagnostic accuracy.展开更多
明确酒精性肝硬化(A lcoholic liver c irrhosis,ALC)和肝炎肝硬化(LC)的超声鉴别诊断。回顾分析我院收治确诊的48例ALC和68例LC患者的超声资料。仪器采用Ph ilips HD I 5000彩超仪,探头3.5MHz,存储图像,脱机分析。ALC患者的超声表现中...明确酒精性肝硬化(A lcoholic liver c irrhosis,ALC)和肝炎肝硬化(LC)的超声鉴别诊断。回顾分析我院收治确诊的48例ALC和68例LC患者的超声资料。仪器采用Ph ilips HD I 5000彩超仪,探头3.5MHz,存储图像,脱机分析。ALC患者的超声表现中:肝体积增大,形态正常,回声弥漫增强的出现率明显高于LC组(P<0.05)。LC的超声表现中:肝体积缩小,形态失常,肝被膜锯齿状,肝内不规则回声增高,表现为网格状高回声或苔藓状或鳞片状高回声等发生率明显高于ALC组。脾肿大,腹水及门脉内径(肝外肝门处测量)两组间无明显差异。得出结论超声有助于鉴别ALC和LC。展开更多
基金Supported by Grant IGA MZCR NT 11 247(The role of protective mechanisms,oxidative stress and inflammatory reaction in the progression of liver damage in patient with metabolic syndrome and possible influence of antioxidative factors on the prevention of liver damage in experimental model of NASH)UK SVV 3362(Regulatory parameters in the pathogenesis of inflammatory and oncologic diseases)
文摘Alcohol use disorders affect millions of individuals worldwide.Alcohol consumption is directly associated with liver disease mortality and accounts for elevated social and economic costs.Alcoholic liver disease(ALD) may take the form of acute involvement(alcoholic hepatitis)or chronic liver disease(steatosis,steatohepatitis,fibrosis and cirrhosis).The severity and prognosis of alcohol-induced liver disease depends on the amount,pattern and duration of alcohol consumption,as well as on the presence of liver inflammation,diet,nutritional status and genetic predisposition of an individual.While steatosis is an almost completely benign disease,liver cirrhosis is associated with marked morbidity,mortal-ity and life expectancy shortening.The median survival of patients with advanced cirrhosis is 1-2 years.Se-vere acute alcoholic hepatitis(AH)is associated with mortality as high as 50%.It has been managed with corticoids,pentoxifylline and enteral nutrition,although evidence based data are still conflicting.Some author suggest that pentoxifylline could be a better first-line treatment in patients with severe AH.Absolute abstinence is a basic condition for any treatment of acute or chronic ALD,the other therapeutical procedure being of a supportive nature and questionable significance.Acamprosate appears to be an effective treatment strategy for supporting continuous abstinence in alco-hol dependent patients.Patients with advanced liver cirrhosis who demonstrably abstain can be considered for liver transplantation,which leads to a markedly pro-longed life expectancy.The crucial step in ALD preven-tion is in the prevention of alcohol abuse,whereas the prevention of liver injury in active alcohol abusers is not clinically applicable.
文摘目的观察丁二磺酸腺苷蛋氨酸联合复方甘草酸苷治疗酒精性肝硬化的疗效及骨钙素(BGP)水平的影响。方法选取该院收治酒精性肝硬化患者102例,随机分为对照组51例与观察组51例。对照组给予复方甘草酸苷注射液60 m L,静滴,1次/天。观察组在对照组基础上予丁二磺酸腺苷蛋氨酸(思美泰)500 mg,口服,2次/天。两组连续治疗4周。比较两组肝功能、肝纤维化水平及临床疗效。检测两组血清BGP水平。结果治疗后,观察组患者血清中丙氨酸氨基转氨酶(ALT)、总胆红素(TBi L)、Ⅲ型前胶原氨基端肽(PCⅢ)、Ⅳ胶原(CⅣ)、层黏连蛋白(LN)和透明质酸(HA)明显低于对照组,白蛋白(ALB)明显高于对照组(P<0.05)。观察组总有效率为92.16%,对照组为74.51%,观察组显著高于对照组(P<0.05)。治疗后4周和8周,观察组患者血清中BGP水平显著高于对照组,比较差异有统计学意义(P<0.01)。结论丁二磺酸腺苷蛋氨酸联合复方甘草酸苷治疗酒精性肝硬化的疗效显著,上调患者血清中BGP水平可能与其治疗效果联系密切。
文摘目的:探讨乙型肝炎病毒(hepatitis B virus,HBV)感染合并酒精性肝病(alcoholic liver disease,ALD)失代偿期肝硬化患者的临床特点,评价HBV感染与酒精性肝病之间的关系,分析其预后,为临床治疗提供参考.方法:采用病例对照研究,严格按照病例和对照的纳入和排除标准,选取2010-01/2015-10在华北理工大学附属医院住院的HBV感染合并ALD的肝硬化失代偿期患者86例作为观察组,选择同期住院的单纯HBV感染肝硬化失代偿期患者94例(乙型肝炎组)、单纯ALD的失代偿期肝硬化患者92例(酒精肝组)作为对照组.对3组患者的临床资料和实验室结果进行回顾性分析,评价3组的治疗效果,分析HBV感染与ALD之间的关系.结果:观察组在乏力、腹胀、食欲不振、黄疸等常见临床表现较乙型肝炎组、酒精肝组相比(P>0.05),差异没有统计学意义,在上消化道出血、肝性脑病、腹水并发症方面差异具有统计学意义(P<0.01);3组患者肝功能指标谷丙转氨酶、谷草转氨酶、胆碱脂酶、总胆红素均有不同程度的异常,且观察组较乙型肝炎组、酒精肝组相比明显加重,差异具有统计学意义(P<0.05);3组患者病理指标,观察组炎症程度较乙型肝炎组、酒精肝组相比,差异具有统计学意义(P<0.05).结论:HBV感染合并ALD对肝脏损伤具有协同作用,会加重肝功能损伤,促使病情恶化,降低治疗效果.
基金Supported by The Dietmar Hopp Foundation and the Manfred Lautenschlger Foundation,an Olympia-Morata fellowship of the University of Heidelberg (Millonig G)
文摘AIM:To test if inflammation also interferes with liver stiffness (LS) assessment in alcoholic liver disease (ALD) and to provide a clinical algorithm for reliable fibrosis assessment in ALD by FibroScan (FS).METHODS:We first performed sequential LS analysis before and after normalization of serum transaminases in a learning cohort of 50 patients with ALD admitted for alcohol detoxification. LS decreased in almost all patients within a mean observation interval of 5.3 d. Six patients (12%) would have been misdiagnosed with F3and F4 fibrosis but LS decreased below critical cut-off values of 8 and 12.5 kPa after normalization of trans-aminases. RESULTS:Of the serum transaminases,the decrease in LS correlated best with the decrease in glutamic oxaloacetic transaminase (GOT). No significant chang-es in LS were observed below GOT levels of 100 U/L. After establishing the association between LS and GOT levels,we applied the rule of GOT < 100 U/L for reliable LS assessment in a second validation cohort of 101 patients with histologically confi rmed ALD. By ex-cluding those patients with GOT > 100 U/L at the time of LS assessment from this cohort,the area under the receiver operating characteristic (AUROC) for cirrhosis detection by FS improved from 0.921 to 0.945 while specificity increased from 80% to 90% at a sensitivity of 96%. A similar AUROC could be obtained for lower F3 fibrosis stage if LS measurements were restricted to patients with GOT < 50 U/L. Histological grading of inflammation did not further improve the diagnostic accuracy of LS.CONCLUSION:Coexisting steatohepatitis markedly increases LS in patients with ALD independent of fibrosis stage. Postponing cirrhosis assessment by FS during alcohol withdrawal until GOT decreases to < 100 U/mL signif icantly improves the diagnostic accuracy.
文摘明确酒精性肝硬化(A lcoholic liver c irrhosis,ALC)和肝炎肝硬化(LC)的超声鉴别诊断。回顾分析我院收治确诊的48例ALC和68例LC患者的超声资料。仪器采用Ph ilips HD I 5000彩超仪,探头3.5MHz,存储图像,脱机分析。ALC患者的超声表现中:肝体积增大,形态正常,回声弥漫增强的出现率明显高于LC组(P<0.05)。LC的超声表现中:肝体积缩小,形态失常,肝被膜锯齿状,肝内不规则回声增高,表现为网格状高回声或苔藓状或鳞片状高回声等发生率明显高于ALC组。脾肿大,腹水及门脉内径(肝外肝门处测量)两组间无明显差异。得出结论超声有助于鉴别ALC和LC。