Tarter R E, Arria A M, Van Thiel D H
Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania 15213.
Recent Dev Alcohol. 1991;9:205-24.
Although it is well established that the majority of alcoholics are neurologically compromised, little is known about the etiological factors underlying the central nervous system (CNS) disturbances. Without doubt, ethanol is a neurotoxin; however, the complex array of factors presaging drinking onset and factors concomitant to a lifestyle of alcohol abuse probably also influence the risk for neurologic injury. This chapter reviews the emerging evidence linking liver disease to the neurologic pathology manifested by chronic alcoholics. The observation that the pattern and severity of cognitive deficits is similar between alcoholics and nonalcoholics with cirrhosis, combined with the demonstration that biochemical indices of liver injury correlate with cognitive test performance in alcoholics, illustrates the important role of liver disease as a codeterminant of the CNS disturbance. In addition, the findings from developing research indicating that liver transplantation can reverse the deficits on neuropsychological tests further underscore the importance of advanced liver disease as a determinant of the CNS pathology, and the results suggest the need for aggressive treatment of alcoholic liver disease for restoring the alcoholic's functional cognitive abilities, which, in turn, may improve the prognosis for psychosocial adjustment.
尽管多数酗酒者存在神经功能受损这一点已得到充分证实，但对于中枢神经系统（CNS）紊乱的潜在病因知之甚少。毫无疑问，乙醇是一种神经毒素；然而，预示饮酒开始的一系列复杂因素以及与酗酒生活方式相关的因素可能也会影响神经损伤的风险。本章回顾了将肝病与慢性酗酒者表现出的神经病理学联系起来的新证据。酗酒者与肝硬化非酗酒者认知缺陷的模式和严重程度相似，同时有证据表明肝病的生化指标与酗酒者的认知测试表现相关，这说明了肝病作为中枢神经系统紊乱共同决定因素的重要作用。此外，正在开展的研究结果表明肝移植可逆转神经心理测试中的缺陷，这进一步强调了晚期肝病作为中枢神经系统病理学决定因素的重要性，结果提示需要积极治疗酒精性肝病以恢复酗酒者的功能性认知能力，进而可能改善心理社会适应的预后。
