中国酒精性肝病的危险因素。
Risk factors for alcoholic liver disease in China.
作者信息
Lu Xiao-Lan, Luo Jin-Yan, Tao Ming, Gen Yan, Zhao Ping, Zhao Hong-Li, Zhang Xiao-Dong, Dong Nei
机构信息
Department of Gastroenterology, Second Hospital of Xi'an Jiaotong University, 157 Xiwulu, Xi'an 710004, Shaanxi Province, China.
出版信息
World J Gastroenterol. 2004 Aug 15;10(16):2423-6. doi: 10.3748/wjg.v10.i16.2423.
AIM
To examine the association of daily alcohol intake, types of alcoholic beverage consumed, drinking patterns and obesity with alcoholic liver disease in China.
METHODS
By random cluster sampling and a 3-year follow-up study, 1 270 alcohol drinkers were recruited from different occupations in the urban and suburban areas of Xi'an City. They were examined by specialists and inquired for information on: Medical history and family medical history, alcohol intake, types of alcoholic beverage consumed, drinking patterns by detailed dietary questionnaires. Routine blood tests and ultrasonography were done.
RESULTS
Multivariate analysis showed that: (1) The risk threshold for developing alcoholic liver disease was ingestion of more than 20 g alcohol per day, keeping on drinking for over 5 years in men. The highest OR was at the daily alcohol consumption > or =160 g, the occurrence rate of ALD amounted to 18.7% (P<0.01). No ALD occurred when ingestion of alcohol was less than 20 g per day. (2) 87.9% of all drank only at mealtimes. The cumulative risk of developing ALD was significantly higher in those individuals who regularly drank alcohol without food than in those who drank only at mealtimes, especially for those who regularly drank hard liquors only and multiple drinks (P<0.05). (3) The alcohol consumption in those with BMI > or =25 was lower than in those with BMI<25, but the risk increased to 11.5%, significantly higher than that of general population, 6.5% (P<0.01). (4) Abstinence and weight reduction could benefit the liver function recovery.
CONCLUSION
In the Chinese population the ethanol risk threshold for developing ALD is 20 g per day, and this risk increases with increased daily intake. Drinking 20 g of ethanol per day and for less than 5 years are safe from ALD. Drinking alcohol outside mealtimes and drinking hard liquors only and multiple different alcohol beverages both increase the risk of developing ALD. Obesity also increases the risk. Abstinence and weight reduction will directly affect the prognosis of ALD. Doctor's strong advice might influence the prognosis indirectly.
目的
探讨中国人群每日酒精摄入量、饮用酒精饮料类型、饮酒方式及肥胖与酒精性肝病的关系。
方法
采用随机整群抽样法，对西安市城乡不同职业的1270名饮酒者进行为期3年的随访研究。由专科医生对其进行检查，并通过详细的饮食问卷询问以下信息：病史及家族病史、酒精摄入量、饮用酒精饮料类型、饮酒方式。同时进行常规血液检查及超声检查。
结果
多因素分析显示：（1）男性每日摄入酒精量超过20g，持续饮酒5年以上是发生酒精性肝病的风险阈值。每日酒精摄入量≥160g时，酒精性肝病发生率最高，达18.7%（P<0.01）。每日酒精摄入量低于20g时未发生酒精性肝病。（2）87.9%的人仅在进餐时饮酒。经常空腹饮酒者发生酒精性肝病的累积风险显著高于仅在进餐时饮酒者，尤其是经常仅饮用烈性酒且多种酒混合饮用者（P<0.05）。（3）体重指数（BMI）≥25者的酒精摄入量低于BMI<25者，但发生酒精性肝病的风险增加至11.5%，显著高于普通人群的6.5%（P<0.01）。（4）戒酒及减轻体重有利于肝功能恢复。
结论
在中国人群中，发生酒精性肝病的乙醇风险阈值为每日20g，且随着每日摄入量增加风险升高。每日摄入20g乙醇且饮酒时间不足5年不会发生酒精性肝病。进餐时间外饮酒、仅饮用烈性酒及多种不同酒精饮料均会增加发生酒精性肝病的风险。肥胖也会增加风险。戒酒及减轻体重将直接影响酒精性肝病的预后。医生的强烈建议可能间接影响预后。
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