Department of Medicine, Brighton and Sussex Medical School, Brighton, UK.
Eur J Gastroenterol Hepatol. 2013 Jun;25(6):659-64. doi: 10.1097/MEG.0b013e32835d83d9.
Despite high recidivism rates in those treated for alcoholism, recurrent episodes of severe alcoholic hepatitis (SAH) have not been described. Our aim was to assess the clinical characteristics and outcomes in recurrent SAH.
A retrospective review of patient records was carried out. Recurrent SAH was defined as two or more discrete episodes of SAH (discriminant function≥32) coinciding with recidivism in the same patient, with documented improvement/resolution of jaundice during intervening periods of abstinence.
Of 56 patients with recidivism following index presentation with SAH, 10 (17.9%) developed recurrent SAH. We report on 17 episodes in seven patients with complete data. The mean age and duration of alcohol use were 47.9±7.4 and 16.1±5.2 years, respectively. Compared with those without recurrence, the cohort with recurrent SAH were more likely to be women (57.1 vs. 34.8%, P=0.405), had higher alcohol consumption during relapse (16.0±15.3 vs. 11.3±8.1 U/day, P=0.591) and a recidivism pattern of alcohol relapse after initial abstinence rather than continuous alcohol use. Recurrent episodes were more severe compared with the index one (discriminant function 70.4±27.9 vs. 50.5±10.9; MELD score 26.2±3.7 vs. 22.1±1.5, P<0.05), the overall mortality being 57.1%. Treatment responses to corticosteroids were consistent in 66.7% of patients.
Approximately 18% of patients, especially women, develop recurrent SAH because of recidivism, with increasing disease severity and mortality approaching 60%. Our data underscore the urgent need to develop strategies to prevent recidivism following index presentation with SAH.
尽管酗酒患者的复发率很高，但尚未描述反复发生的严重酒精性肝炎（SAH）。我们的目的是评估复发性 SAH 的临床特征和结局。
对患者病历进行了回顾性审查。复发性 SAH 定义为同一患者出现两次或两次以上离散的 SAH 发作（判别函数≥32），同时伴有戒酒后黄疸缓解/消退的复发。
在首次出现 SAH 后出现复发的 56 例患者中，有 10 例（17.9%）发生复发性 SAH。我们报告了 7 例患者中 17 个完整数据的发作。患者的平均年龄和饮酒时间分别为 47.9±7.4 岁和 16.1±5.2 年。与无复发的患者相比，复发性 SAH 组女性更多（57.1% vs. 34.8%，P=0.405），复发时的酒精摄入量更高（16.0±15.3 vs. 11.3±8.1 U/天，P=0.591），且复发性 SAH 的模式为初始戒酒后而非持续饮酒后酒精复发。复发性发作比首发更严重（判别函数 70.4±27.9 vs. 50.5±10.9；MELD 评分 26.2±3.7 vs. 22.1±1.5，P<0.05），总死亡率为 57.1%。皮质类固醇治疗的反应在 66.7%的患者中是一致的。
大约 18%的患者，尤其是女性，由于复发而出现复发性 SAH，疾病的严重程度和死亡率均接近 60%。我们的数据强调了迫切需要制定策略来预防首次出现 SAH 后的复发。
