Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain.
Municipal Centre for Substance Abuse Treatment (Centro Delta), Badalona, Spain.
Drug Alcohol Depend. 2018 Sep 1;190:195-199. doi: 10.1016/j.drugalcdep.2018.06.012. Epub 2018 Jul 19.
To analyze ultrasound findings of liver damage in alcohol use disorder (AUD) patients.
A cross-sectional analysis of detoxification patients. Clinical and laboratory parameters were obtained at admission. Analytical liver injury (ALI) was defined as at least two of the following: aspartate aminotransferase (AST) levels ≥74 < 300 U/L, AST/alanine aminotransferase (ALT) ratio >2, and total bilirubin >1.2 mg/dL. Advanced liver fibrosis (ALF) was defined as a FIB-4 score ≥3.25. Abdominal ultrasound was used to identify steatosis, hepatomegaly, heterogeneous liver, and portal hypertension. Predictors of these findings were determined by logistic regression.
We included 301 patients (80% male) with a median age of 46 years (IQR: 39-51 years) and alcohol consumption of 180 g/day (IQR: 120-201 g). The prevalence of Hepatitis C virus (HCV) was 21.2%; AST and ALT serum levels were 42 U/L (IQR: 23-78 U/L) and 35 U/L (IQR: 19-60 U/L), respectively; 16% of patients had ALI and 24% ALF. Ultrasound findings were: 57.2% steatosis, 49.5% hepatomegaly, 17% heterogeneous liver, and 16% portal hypertension; 77% had at least one ultrasound abnormality, and 45% had ≥2. HCV infection was associated with heterogeneous liver (p = 0.046) and portal hypertension (p < 0.01). ALI and ALF were associated with steatosis (both p < 0.01) and hepatomegaly (both p < 0.01), ALI with portal hypertension (p = 0.08), and ALF with heterogeneous liver (p < 0.01). In logistic regression, ALI and ALF were associated with ≥2 abnormalities [OR (95%CI): 5.2 (2.1-12.8), p < 0.01 and 4.7 (2.2-9.7), p < 0.01; respectively].
Ultrasound findings of liver damage may facilitate clinical decisions and alcohol cessation in AUD patients.
分析酒精使用障碍（AUD）患者的肝脏损伤的超声表现。
对戒毒患者进行横断面分析。入院时获得临床和实验室参数。分析性肝损伤（ALI）定义为至少有以下两项：天冬氨酸转氨酶（AST）水平≥74<300 U/L，AST/丙氨酸转氨酶（ALT）比值>2，总胆红素>1.2mg/dL。晚期肝纤维化（ALF）定义为 FIB-4 评分≥3.25。腹部超声用于识别脂肪肝、肝肿大、肝不均匀和门脉高压。通过逻辑回归确定这些发现的预测因素。
我们纳入了 301 名（80%为男性）中位年龄为 46 岁（IQR：39-51 岁）、每日饮酒量为 180g（IQR：120-201g）的患者。丙型肝炎病毒（HCV）的患病率为 21.2%；AST 和 ALT 血清水平分别为 42U/L（IQR：23-78U/L）和 35U/L（IQR：19-60U/L）；16%的患者有 ALI，24%有 ALF。超声表现为：57.2%脂肪肝，49.5%肝肿大，17%肝不均匀，16%门脉高压；77%的患者至少有一项超声异常，45%的患者有≥2项异常。HCV 感染与肝不均匀（p=0.046）和门脉高压（p<0.01）相关。ALI 和 ALF 与脂肪肝（均 p<0.01）和肝肿大（均 p<0.01）相关，ALI 与门脉高压（p=0.08）相关，ALF 与肝不均匀（p<0.01）相关。在逻辑回归中，ALI 和 ALF 与≥2 项异常相关[比值比（95%CI）：5.2（2.1-12.8），p<0.01 和 4.7（2.2-9.7），p<0.01]。
超声检查肝脏损伤的结果可有助于 AUD 患者的临床决策和戒酒。
