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酒精性肝硬化与慢性胰腺炎的巧合

[The coincidence of alcoholic liver cirrhosis and chronic pancreatitis].

作者信息

Spicák J, Pulkertová A, Králová-Lesná I, Suchánek P, Vitásková M, Adámková V

机构信息

Klinika hepatogastroenterologie IKEM Praha.

出版信息

Vnitr Lek. 2011 Dec;57(12):1045-52.

Abstract

UNLABELLED

INTRODUCTION, STUDY AIM: Health consequences of alcoholism vary and include a wide range of pathological conditions from mental disorders to disorders of various parenchymatous organs. There are many differences between alcohol abusers, from the way they abuse alcohol to the nature of bodily harm. The aim of this prospective study was to map and correlate organ involvement with the type of alcohol abuse and smoking and dietary habits.

METHODS

A prospective study analyzing a questionnaire on alcoholism, smoking, diet and lifestyle habits completed by 146 patients with liver cirrhosis and chronic pancreatitis.

RESULTS

Of the 80 liver cirrhosis patients with the mean age of47.5 year (23-60 years, SD 8.58), 64 were men and 16 (20%) were women. Of the 60 chronic pancreatitis patients with the mean age of 37.8 year (23-60 years, SD 9.66), 60 were men and 6 (9.1%) were women. The mean daily alcohol intake was 57.7 g in patients with cirrhosis and 63.7 g per day in patients with pancreatitis. The first contact with alcohol before 15th year of age was reported by 25.8% of patients with pancreatitis and 8.8% of patients with cirrhosis. Age under 30 years as the period with the largest intake of alcohol was reported by 43.6% of patients with pancreatitis and 20.3% of patients with cirrhosis. There was a statistically significant difference in the type of alcohol used; patients with pancreatitis predominantly drank beer. 16.7% of patients with pancreatitis and 3.7% of patients with cirrhosis started to smoke before 15th year of age. 66.7% of patients with pancreatitis and 40% of patients with cirrhosis left education before achieving collage state exam, 9.1% of patients with pancreatitis and 25% of patients with cirrhosis had university education. Cirrhosis was diagnosed in 11 (16.7%) patients with chronic pancreatitis. In all patients, this was functional disorder Child-Pugh stage A, decompensation occurred in 54.5% of patients. Portal hypertension was diagnosed in 72.7% of patients and thrombosis of v. portae orv. lieanlis in 12 patients. Bleeding from gastroesophageal varices occurred in 1 patient with chronic pancreatitis, liver cirrhosis and v. portae thrombosis. Chronic pancreatitis was diagnosed in 2 (2.5%) patients with livercirrhosis. With respect to comorbidities, chronic obstructive bronchopulmonary disease and ischemic heart disease was significantly more frequent in patients with chronic pancreatitis.

CONCLUSION

There are differences in social-behavioural background of both relatively common organ disorders. Chronic pancreatitis is more prevalent in people with lower education. The first contact with alcohol and regular abuse occur at younger age, smoking is also more frequent, with earlier onset. Both diseases rarely occur concurrently and simultaneous decompensation of both organs is not seen. We could speculate that early exposition to the known aetiopathogenic factors affect primarily pancreas. The rare concurrence of both diseases, particularly of their advanced stages, opposes all known theories.

摘要

未标注

引言、研究目的:酒精中毒对健康的影响各不相同,包括从精神障碍到各种实质器官疾病等广泛的病理状况。酗酒者之间存在许多差异,从他们酗酒的方式到身体伤害的性质。这项前瞻性研究的目的是描绘器官受累情况,并将其与酗酒类型、吸烟和饮食习惯相关联。

方法

一项前瞻性研究,分析了146例肝硬化和慢性胰腺炎患者填写的关于酗酒、吸烟、饮食和生活方式习惯的问卷。

结果

80例肝硬化患者的平均年龄为47.5岁(23 - 60岁,标准差8.58),其中64例为男性,16例(20%)为女性。60例慢性胰腺炎患者的平均年龄为37.8岁(23 - 60岁,标准差9.66),其中60例为男性,6例(9.1%)为女性。肝硬化患者的平均每日酒精摄入量为57.7克,胰腺炎患者为每日63.7克。25.8%的胰腺炎患者和8.8%的肝硬化患者报告在15岁之前首次接触酒精。43.6%的胰腺炎患者和20.3%的肝硬化患者报告30岁以下是酒精摄入量最大的时期。所使用酒精的类型存在统计学显著差异;胰腺炎患者主要饮用啤酒。16.7%的胰腺炎患者和3.7%的肝硬化患者在15岁之前开始吸烟。66.7%的胰腺炎患者和40%的肝硬化患者在未完成大学国家考试之前就辍学了,9.1%的胰腺炎患者和25%的肝硬化患者拥有大学学历。11例(16.7%)慢性胰腺炎患者被诊断出患有肝硬化。在所有患者中,这是Child - Pugh A级功能障碍,54.5%的患者出现失代偿。72.7%的患者被诊断出患有门静脉高压,12例患者出现门静脉或肝静脉血栓形成。1例患有慢性胰腺炎、肝硬化和门静脉血栓形成的患者发生了胃食管静脉曲张出血。2例(2.5%)肝硬化患者被诊断出患有慢性胰腺炎。关于合并症,慢性阻塞性肺疾病和缺血性心脏病在慢性胰腺炎患者中明显更常见。

结论

这两种相对常见的器官疾病在社会行为背景方面存在差异。慢性胰腺炎在受教育程度较低的人群中更为普遍。首次接触酒精和经常酗酒发生在较年轻的年龄,吸烟也更频繁,发病更早。这两种疾病很少同时发生,且未观察到两个器官同时失代偿的情况。我们可以推测,早期接触已知的病因致病因素主要影响胰腺。这两种疾病的罕见同时发生,尤其是它们的晚期,与所有已知理论相悖。

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