Verrill Clare, Smith Stewart, Sheron Nick
Histopathology Department, Southampton University Hospitals NHS Trust, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
Subst Abuse Treat Prev Policy. 2006 Jun 15;1:16. doi: 10.1186/1747-597X-1-16.
Deaths from liver cirrhosis have increased at least 8 fold since the 1970's in the UK and further increases are anticipated, whereas in the rest of Europe liver deaths are decreasing. In the UK, we urgently need strategies to detect those who misuse alcohol and are at risk of developing alcoholic liver disease before they get to that point. One potential strategy is to screen admissions to hospital with alcohol related conditions for evidence of alcohol misuse.Surprisingly, there has been no research into the important question of where the opportunities are to detect those who misuse alcohol - primary or secondary care. We attempted to answer this firstly by conducting a retrospective analysis of the medical notes of 94 patients diagnosed with alcohol induced liver cirrhosis between 1st January 1995 and 31st December 2000 at Southampton General Hospital with the purpose of identifying admissions to hospital prior to a diagnosis of alcoholic liver disease. In the second part of the study, we interviewed patients with alcoholic liver disease about their contact with health services.
Before diagnosis of alcoholic liver disease, 33% (31/94) of the patients had had an admission to hospital for an alcohol related condition. There was a mean of 7 years and 1 month (SD 6 years 3 months) between the first alcohol-related admission and presentation with alcoholic liver disease (in those who had had admissions). The commonest reason for alcohol related admission was falls/fractures/injuries, followed by non-variceal gastro-intestinal bleeds. Patients with alcoholic liver disease who were interviewed had seen their General Practitioner on average at least 2 times per year.
Most patients who develop alcohol-induced cirrhosis do not have an admission to hospital with an alcohol related condition before developing alcoholic liver disease. Therefore, if we screen patients admitted to hospital with alcohol related conditions for evidence of alcohol misuse, we could potentially detect around a third of those at risk of developing cirrhosis. Although secondary care has an important role to play in detecting those at risk, the main opportunity for detection is in primary care.
自20世纪70年代以来，英国肝硬化导致的死亡人数至少增加了8倍，预计还会进一步增加，而在欧洲其他地区，肝脏疾病导致的死亡人数正在减少。在英国，我们迫切需要制定策略，以便在那些滥用酒精且有发展为酒精性肝病风险的人病情发展到严重程度之前就将其检测出来。一种潜在策略是，对因酒精相关疾病入院的患者进行筛查，以寻找酒精滥用的证据。令人惊讶的是，对于在何处（初级保健还是二级保健机构）有机会检测出酒精滥用者这个重要问题，尚未开展研究。我们首先通过对1995年1月1日至2000年12月31日期间在南安普敦总医院被诊断为酒精性肝硬化的94例患者的病历进行回顾性分析，目的是确定在诊断酒精性肝病之前的入院情况。在研究的第二部分，我们就酒精性肝病患者与医疗服务机构的接触情况对他们进行了访谈。
在诊断酒精性肝病之前，33%（31/94）的患者曾因酒精相关疾病入院。首次因酒精相关疾病入院到出现酒精性肝病（在那些有过入院经历的患者中）的平均间隔时间为7年零1个月（标准差为6年零3个月）。因酒精相关疾病入院最常见的原因是跌倒/骨折/受伤，其次是非静脉曲张性胃肠道出血。接受访谈的酒精性肝病患者平均每年至少看2次全科医生。
大多数发展为酒精性肝硬化的患者在患酒精性肝病之前没有因酒精相关疾病入院。因此，如果我们对因酒精相关疾病入院的患者进行筛查以寻找酒精滥用的证据，我们有可能检测出约三分之一有发展为肝硬化风险的人。虽然二级保健机构在检测有风险的人方面可发挥重要作用，但主要的检测机会在初级保健机构。
