Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.
Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Ontario, Canada.
Am J Gastroenterol. 2019 Oct;114(10):1574-1586. doi: 10.14309/ajg.0000000000000340.
To systematically summarize the risk relationship between different levels of alcohol consumption and incidence of liver cirrhosis.
MEDLINE and Embase were searched up to March 6, 2019, to identify case-control and cohort studies with sex-specific results and more than 2 categories of drinking in relation to the incidence of liver cirrhosis. Study characteristics were extracted and random-effects meta-analyses and meta-regressions were conducted.
A total of 7 cohort studies and 2 case-control studies met the inclusion criteria, providing data from 2,629,272 participants with 5,505 cases of liver cirrhosis. There was no increased risk for occasional drinkers. Consumption of one drink per day in comparison to long-term abstainers showed an increased risk for liver cirrhosis in women, but not in men. The risk for women was consistently higher compared to men. Drinking ≥5 drinks per day was associated with a substantially increased risk in both women (relative risk [RR] = 12.44, 95% confidence interval [CI]: 6.65-23.27 for 5-6 drinks, and RR = 24.58, 95% CI: 14.77-40.90 for ≥7 drinks) and men (RR = 3.80, 95% CI: 0.85-17.02, and RR = 6.93, 95% CI: 1.07-44.99, respectively). Heterogeneity across studies indicated an additional impact of other risk factors.
Alcohol is a major risk factor for liver cirrhosis with risk increasing exponentially. Women may be at higher risk compared to men even with little alcohol consumption. More high-quality research is necessary to elucidate the role of other risk factors, such as genetic vulnerability, body weight, metabolic risk factors, and drinking patterns over the life course. High alcohol consumption should be avoided, and people drinking at high levels should receive interventions to reduce their intake.
系统总结不同饮酒水平与肝硬化发病风险的关系。
检索 MEDLINE 和 Embase 数据库，截至 2019 年 3 月 6 日，纳入有性别特异性结果且饮酒与肝硬化发病风险相关的病例对照研究和队列研究，且研究至少分为 2 个饮酒组。提取研究特征并进行随机效应荟萃分析和荟萃回归分析。
共纳入 7 项队列研究和 2 项病例对照研究，共纳入 2629272 名参与者，其中 5505 例发生肝硬化。偶尔饮酒者发病风险未见增加。与长期戒酒者相比，女性每天饮酒 1 份与肝硬化发病风险增加相关，但男性无此相关性。女性的发病风险始终高于男性。女性每天饮酒≥5 份与肝硬化发病风险显著增加相关（5-6 份时 RR = 12.44，95%CI：6.65-23.27；≥7 份时 RR = 24.58，95%CI：14.77-40.90），男性每天饮酒≥5 份与肝硬化发病风险增加相关（RR = 3.80，95%CI：0.85-17.02；RR = 6.93，95%CI：1.07-44.99）。各研究间存在异质性，表明其他危险因素也有一定影响。
酒精是肝硬化的主要危险因素，且风险随饮酒量呈指数增加。即使少量饮酒，女性发病风险也可能高于男性。需要更多高质量的研究来阐明其他危险因素的作用，如遗传易感性、体重、代谢危险因素和终生饮酒模式。应避免大量饮酒，饮酒量高的人群应采取干预措施减少饮酒量。
