Gastro Unit, Copenhagen University Hospital, Bispebjerg Hospital, DK-2400, Copenhagen, Denmark.
National Institute of Public Health, University of Southern Denmark, DK-1455, Copenhagen, Denmark.
Am J Gastroenterol. 2019 Feb;114(2):221-232. doi: 10.1038/s41395-018-0282-6.
Alcoholic liver cirrhosis is preventable and caused by heavy drinking. Few in the general population may be at risk and interventions targeting individuals at high risk may be a more feasible opportunity for prevention than interventions targeting the whole population.
We conducted a systematic review to identify opportunities to prevent alcoholic liver cirrhosis in high-risk populations. Following MOOSE guidelines, we included observational studies published between 1980 and 2017. Prospective studies of alcohol-problem cohorts were included to investigate whether alcohol-problem cohorts qualify as high-risk populations for alcoholic liver cirrhosis. Studies on the alcohol amount consumed by alcoholic liver cirrhosis patients were included to compare with the amount consumed by the general population. Moreover, studies on alcohol-related healthcare contacts prior to alcoholic liver cirrhosis diagnosis were included to identify opportunities to offer prevention interventions. Of 7198 screened references, 38 studies (N = 120,928) were included.
Alcohol-problem cohorts qualified as high-risk populations with an incidence of alcoholic liver cirrhosis ranging from 7 to 16% after 8-12 years. The alcohol amount consumed by alcoholic liver cirrhosis patients was high compared to the general population. For example, 45% (95%CI 34, 56) of alcoholic liver cirrhosis patients were drinking >110 g alcohol/day. Finally, there were opportunities to reach alcoholic liver cirrhosis patients prior to diagnosis; 40-61% of alcoholic liver cirrhosis patients had a previous alcohol-related healthcare contact.
We conclude that alcohol-problem cohorts are high-risk populations for alcoholic liver cirrhosis and there seems to be opportunities to reach later alcoholic liver cirrhosis cases with preventive interventions in healthcare settings.
酒精性肝硬化是可预防的，由酗酒引起。普通人群中可能只有少数人有患病风险，针对高危人群的干预措施可能比针对整个人群的干预措施更可行。
我们进行了一项系统评价，以确定在高危人群中预防酒精性肝硬化的机会。根据 MOOSE 指南，我们纳入了 1980 年至 2017 年期间发表的观察性研究。纳入了前瞻性酒精问题队列研究，以调查酒精问题队列是否符合酒精性肝硬化的高危人群标准。纳入了酒精性肝硬化患者饮酒量的研究，以与普通人群的饮酒量进行比较。此外，还纳入了酒精相关医疗保健接触的研究，以确定提供预防干预的机会。在筛选出的 7198 篇参考文献中，有 38 项研究（N=120928）符合纳入标准。
酒精问题队列的发病率为 8-12 年后为 7-16%，符合高危人群标准，发生酒精性肝硬化。酒精性肝硬化患者的饮酒量与普通人群相比很高。例如，45%（95%CI 34, 56）的酒精性肝硬化患者每天饮酒量超过 110 克。最后，在诊断前有机会接触到酒精性肝硬化患者；40-61%的酒精性肝硬化患者有过与酒精相关的医疗保健接触。
我们的结论是，酒精问题队列是酒精性肝硬化的高危人群，在医疗保健环境中似乎有机会通过预防干预措施接触到后来的酒精性肝硬化病例。
