Shoreibah Mohamed, Raff Evan, Bloomer Joseph, Kakati Donny, Rasheed Khalid, Kuo Yong-Fang, Singal Ashwani K
Division of Gastroenterology and Hepatology.
Department of Internal Medicine, UAB, Birmingham, AL, USA.
Ann Hepatol. 2016 Mar-Apr;15(2):183-9. doi: 10.5604/16652681.1193707.
Steatohepatitis is a common cause of liver disease due to alcohol (ALD) or non-alcoholic fatty liver disease (NAFLD). We performed this study to compare natural history of ALD and NAFLD.
Retrospective analysis of ALD or NAFLD patients managed at our center (2007-2011). ALD diagnosed by excluding other liver diseases (except HCV) and alcohol abuse of > 40 g/d in women and > 60 g/d in men for > 5 years. NAFLD diagnosed by excluding other liver diseases and a history of alcohol use of < 10 g/d. Cirrhosis was diagnosed using biopsy for uncertain clinical diagnosis.
Compared to patients with NAFLD (n = 365; mean age 50 yrs; 43% males; 53% diabetic), ALD patients (n = 206; mean age 51 yrs; 68% males; 24% diabetic) presented more often with cirrhosis or complications(46vs. 12%; P< 0.0001) with a higher MELD score (13 ± 7 vs. 8 ± 8; P<0.0001). On logistic regression, ALD diagnosis was associated with presence of cirrhosis by over 4-fold (4.1 [1.8-9.1]) even after excluding 23 patients with concomitant HCV. Over median follow up of about 3 and 4 yrs among ALD and NAFLD patients respectively, ALD patients more frequently developed cirrhosis or its complications including HCC with worse transplant free survival (90 vs. 95%; P = 0.038).
Compared to NAFLD, ALD patients present at an advanced stage of liver disease with a faster progression on follow-up. Prospective multicenter studies are needed to identify potential barriers to early referral of ALD patients as basis for development of strategies to improve outcome of patients with ALD.
脂肪性肝炎是酒精性肝病（ALD）或非酒精性脂肪性肝病（NAFLD）导致肝脏疾病的常见病因。我们开展本研究以比较ALD和NAFLD的自然病程。
对在我们中心接受治疗的ALD或NAFLD患者（2007 - 2011年）进行回顾性分析。ALD的诊断是通过排除其他肝脏疾病（除HCV外），且女性每日酒精摄入量>40克、男性每日酒精摄入量>60克，持续超过5年。NAFLD的诊断是通过排除其他肝脏疾病且有每日酒精摄入量<10克的饮酒史。对于临床诊断不明确的情况，通过活检诊断肝硬化。
与NAFLD患者（n = 365；平均年龄50岁；43%为男性；53%患有糖尿病）相比，ALD患者（n = 206；平均年龄51岁；68%为男性；24%患有糖尿病）更常出现肝硬化或并发症（46%对12%；P<0.0001），且终末期肝病模型（MELD）评分更高（13±7对8±8；P<0.0001）。在逻辑回归分析中，即使排除23例合并HCV的患者，ALD诊断与肝硬化的存在仍有超过4倍的关联（4.1[1.8 - 9.1]）。在ALD和NAFLD患者中，分别进行约3年和4年的中位随访，ALD患者更频繁地发展为肝硬化或其并发症，包括肝癌，且无移植生存期更差（90%对95%；P = 0.038）。
与NAFLD相比，ALD患者在肝病晚期出现，随访中病情进展更快。需要开展前瞻性多中心研究以确定ALD患者早期转诊的潜在障碍，作为制定改善ALD患者预后策略的基础。
