Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India.
Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
Liver Int. 2019 Jan;39(1):168-176. doi: 10.1111/liv.13958. Epub 2018 Sep 29.
BACKGROUND & AIMS: Familial aggregation of metabolic traits in NAFLD is well documented. However, relevance of these traits in alcoholic cirrhosis is not well studied. We aimed to explore the association of family history of metabolic traits with age at diagnosis, severity and complications of alcoholic cirrhosis.
In a cross-sectional study, all consecutive patients with alcoholic cirrhosis presenting to our tertiary care centre were included. Family and personal history, demographic characteristics, medical history, anthropometric measurements and laboratory data were recorded. The amount and duration of alcohol consumption were also carefully recorded.
Out of 1084 alcoholic cirrhotics (age 48.5 ± 10.1 years, all males), family history for metabolic traits was documented in 688 (63.5%) patients. These patients had younger age at diagnosis, increased incidence of jaundice, ascites, variceal bleed and hepatic encephalopathy with consequently higher MELD and CTP score. These patients developed cirrhosis despite shorter median duration (13 years, IQR 7-20 vs 21, IQR 18-25) and lesser amount of alcohol consumption (74 g/d, IQR 24-96 vs 144, IQR 100-148). Patients with both family and personal history of metabolic traits had a higher risk by 3.3 times (95% CI 2.2-4.8) of an early age at diagnosis, 13.2 times (95% CI 8.7-20.1) of progression to cirrhosis with lesser amount of alcohol consumption and 4.6 times (95% CI 3.1-6.9) with lesser duration of alcohol consumption.
Positive family and personal history of metabolic traits predispose to alcoholic cirrhosis with an earlier age at onset and more severity despite lesser exposure to alcohol.
非酒精性脂肪性肝病（NAFLD）的代谢特征存在家族聚集性，这已得到充分证实。然而，这些特征在酒精性肝硬化中的相关性尚未得到充分研究。本研究旨在探讨家族代谢特征史与酒精性肝硬化的诊断年龄、严重程度和并发症之间的关系。
采用横断面研究，纳入我院收治的所有连续酒精性肝硬化患者。记录家族史和个人史、人口统计学特征、既往病史、体格检查测量值和实验室数据。还仔细记录了酒精摄入量的量和时间。
在 1084 名酒精性肝硬化患者（年龄 48.5±10.1 岁，均为男性）中，有 688 名（63.5%）患者有代谢特征的家族史。这些患者的诊断年龄较小，黄疸、腹水、静脉曲张出血和肝性脑病的发生率较高，因此 MELD 和 CTP 评分较高。尽管中位饮酒时间较短（13 年，IQR 7-20 与 21 年，IQR 18-25），酒精摄入量较少（74 g/d，IQR 24-96 与 144 g/d，IQR 100-148），但这些患者仍发展为肝硬化。有家族和个人代谢特征史的患者，其诊断年龄更早的风险增加 3.3 倍（95%CI 2.2-4.8），进展为肝硬化的风险增加 13.2 倍（95%CI 8.7-20.1），且酒精暴露时间更短，进展为肝硬化的风险增加 4.6 倍（95%CI 3.1-6.9），酒精暴露时间更短。
阳性的家族和个人代谢特征史使患者易患酒精性肝硬化，即使暴露于酒精的时间较短，也会更早发病，且病情更严重。
