Departement of Gastroenterology and Hepatology, Hôpital de Jolimont, Haine-Saint-Paul, Belgium.
Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
J Hepatol. 2016 Sep;65(3):543-51. doi: 10.1016/j.jhep.2016.04.031. Epub 2016 May 13.
BACKGROUND & AIMS: Whether alcohol intake increases the risk of complications in patients with HCV-related cirrhosis remains unclear. The aim of this study was to determine the impact of alcohol intake and viral eradication on the risk of hepatocellular carcinoma (HCC), decompensation of cirrhosis and death.
Data on alcohol intake and viral eradication were prospectively collected in 192 patients with compensated HCV-related cirrhosis.
74 patients consumed alcohol (median alcohol intake: 15g/day); 68 reached viral eradication. During a median follow-up of 58months, 33 patients developed HCC, 53 experienced at least one decompensation event, and 39 died. The 5-year cumulative incidence rate of HCC was 10.6% (95% CI: 4.6-16.6) in abstainers vs. 23.8% (95% CI: 13.5-34.1) in consumers (p=0.087), and 2.0% (95% CI: 0-5.8) vs. 21.7% (95% CI: 14.2-29.2) in patients with and without viral eradication (p=0.002), respectively. The lowest risk of HCC was observed for patients without alcohol intake and with viral eradication (0%) followed by patients with alcohol intake and viral eradication (6.2% [95% CI: 0-18.4]), patients without alcohol intake and no viral eradication (15.9% [95% CI: 7.1-24.7]), and patients with alcohol intake and no viral eradication (29.2% [95% CI: 16.5-41.9]) (p=0.009). In multivariate analysis, lack of viral eradication and alcohol consumption were associated with the risk of HCC (hazard ratio for alcohol consumption: 3.43, 95% CI: 1.49-7.92, p=0.004). Alcohol intake did not influence the risk of decompensation or death.
Light-to-moderate alcohol intake increases the risk of HCC in patients with HCV-related cirrhosis. Patient care should include measures to ensure abstinence.
Whether alcohol intake increases the risk of complications in patients with HCV-related cirrhosis remains unclear. In this prospective study, light-to-moderate alcohol intake was associated with the risk of hepatocellular carcinoma in multivariate analysis. No patients who did not use alcohol and who reached viral eradication developed hepatocellular carcinoma during follow-up. The risk of hepatocellular carcinoma increased with alcohol intake or in patients without viral eradication and was highest when alcohol intake was present in the absence of viral eradication. Patients with HCV-related cirrhosis should be strongly advised against any alcohol intake. Patient care should include measures to ensure abstinence.
酒精摄入是否会增加 HCV 相关肝硬化患者发生并发症的风险仍不清楚。本研究旨在确定酒精摄入和病毒清除对肝细胞癌（HCC）、肝硬化失代偿和死亡风险的影响。
前瞻性收集 192 例代偿性 HCV 相关肝硬化患者的酒精摄入和病毒清除数据。
74 例患者饮酒（中位饮酒量：15g/天）；68 例达到病毒清除。中位随访 58 个月期间，33 例患者发生 HCC，53 例患者至少经历一次失代偿事件，39 例患者死亡。在戒酒者中，5 年 HCC 的累积发生率为 10.6%（95%CI：4.6-16.6），在饮酒者中为 23.8%（95%CI：13.5-34.1）（p=0.087）；在病毒清除者中，5 年 HCC 的累积发生率为 2.0%（95%CI：0-5.8），在未病毒清除者中为 21.7%（95%CI：14.2-29.2）（p=0.002）。无酒精摄入且病毒清除者 HCC 风险最低（0%），其次为酒精摄入且病毒清除者（6.2%[95%CI：0-18.4]）、无酒精摄入且无病毒清除者（15.9%[95%CI：7.1-24.7]）和酒精摄入且无病毒清除者（29.2%[95%CI：16.5-41.9]）（p=0.009）。多变量分析显示，病毒未清除和饮酒与 HCC 风险相关（饮酒的 HR：3.43，95%CI：1.49-7.92，p=0.004）。饮酒并未增加失代偿或死亡的风险。
轻至中度饮酒会增加 HCV 相关肝硬化患者发生 HCC 的风险。患者管理应包括戒酒措施。
医脉通译
