Mathurin P, Beuzin F, Louvet A, Carrié-Ganne N, Balian A, Trinchet J C, Dalsoglio D, Prevot S, Naveau S
Service Maladies de l'Appareil Digestif, Hôpital Huriez, CHRU de Lille, Lille, and ISERM 0114, Univ de Lille, Lille, France.
Aliment Pharmacol Ther. 2007 May 1;25(9):1047-54. doi: 10.1111/j.1365-2036.2007.03302.x.
Studies using consecutive liver biopsies constitute an attractive approach to gaining insight into the pathogenesis of alcoholic liver disease.
To analyse histological factors at baseline, which are predictive of fibrosis progression and recurrence of alcoholic hepatitis.
A total of 193 drinkers underwent consecutive biopsies at an interval of 4 years. At baseline, 20 had normal livers, 135 steatosis, five fibrosis and 33 alcoholic hepatitis. The fibrosis score increased from 1.07 +/- 0.07 to 1.7 +/- 0.94 (P < 0.001). In multivariate analysis, only steatosis (P = 0.04), alcoholic hepatitis (P = 0.0004) and stage of fibrosis (P < 0.0001) were independent predictive factors of the fibrosis score at the second biopsy. Cirrhosis developed more frequently in patients with steatosis (11%) and alcoholic hepatitis (39%) than in others (0%, P < 0.0001). Alcoholic hepatitis recurred more frequently in patients with alcoholic hepatitis at baseline: 58% vs. 15%, P < 0.0001. In multivariate analysis, alcoholic hepatitis at the first biopsy was the only predictive factor of its recurrence (P < 0.0001).
In a large cohort of drinkers with consecutive biopsies, steatosis, fibrosis stage and alcoholic hepatitis at baseline were independent predictive factors of fibrosis progression. In terms of mechanisms, we propose a novel concept of multiple hits of alcoholic hepatitis occurring in the same patient.
采用连续肝活检的研究是深入了解酒精性肝病发病机制的一种有吸引力的方法。
分析基线时的组织学因素，这些因素可预测纤维化进展和酒精性肝炎复发。
共有193名饮酒者每隔4年接受连续活检。基线时，20人肝脏正常，135人有脂肪变性，5人有纤维化，33人有酒精性肝炎。纤维化评分从1.07±0.07增加到1.7±0.94（P<0.001）。多因素分析显示，只有脂肪变性（P=0.04）、酒精性肝炎（P=0.0004）和纤维化分期（P<0.0001）是第二次活检时纤维化评分的独立预测因素。脂肪变性患者（11%）和酒精性肝炎患者（39%）发生肝硬化的频率高于其他患者（0%，P<0.0001）。基线时有酒精性肝炎的患者酒精性肝炎复发更频繁：58%对15%，P<0.0001。多因素分析显示，首次活检时的酒精性肝炎是其复发的唯一预测因素（P<0.0001）。
在一大群接受连续活检的饮酒者中，基线时的脂肪变性、纤维化分期和酒精性肝炎是纤维化进展的独立预测因素。在机制方面，我们提出了同一患者发生多次酒精性肝炎打击的新概念。
