Ali Samjo Shoukat, Abbas Zaigham, Asim Muhammad, Tahir Kanwal
Gastroenterology and Hepatology, Ziauddin University Hospital, Karachi, PAK.
Gastroenterology, Ziauddin University Hospital, Karachi, PAK.
Cureus. 2020 Mar 12;12(3):e7251. doi: 10.7759/cureus.7251.
Introduction The purpose of this study was to discern the pattern of alcohol consumption and the severity of alcohol-related liver disease (ARLD) in patients visiting the tertiary care hospital. Methods A cross-sectional study was conducted at Dr. Ziauddin Hospital Clifton campus, Karachi. Patients visiting the liver clinic with disturbed liver enzymes and a history of alcohol intake after excluding other causes were included. A detailed history, routine investigations, insulin level, abdominal ultrasound, and transient elastography were performed. Results A total of 155 patients were included in the study, 98% of whom were men. The median age was 45.93 years (range: 18-78 years). Just over three-fourths of the visiting patients were Muslim (n=119; 76.8%). The median duration of alcohol intake was 5.7 years. All patients admitted to consuming alcohol on an empty stomach before dinner. The most common associated addiction was smoking (n=95; 61.2%). Around two-thirds of patients confessed to binge drinking (n=66; 42.9%). According to the Diagnostic and Statistical Manual of Mental Disorders criteria, 92 patients (59.35%) were alcohol dependent. Hepatic steatosis was positively correlated with the weight of patients (p=0.035). Other factors positively correlated with hepatic steatosis included insulin resistance (p=0.031), elevated uric acid levels (p=0.003), and units of alcohol intake (p=0.054). Significant fibrosis (F3-F4) was present in 73 (47.09%) patients. It was correlated with low platelet count, total bilirubin, aspartate aminotransferase, gamma-glutamyl transpeptidase, alkaline phosphatase, international normalized ratio, albumin, uric acid, controlled attenuation parameter, and units of alcohol intake with significant p-values. Further multivariant analysis showed liver fibrosis was correlated with cholesterol level with a significant p-value (p=0.045). Conclusion ARLD is mainly a male-dominant disease in our population. Most patients consumed a large volume of highly concentrated alcohol and were alcohol dependent. Insulin resistance was observed in a significant number of patients.
引言 本研究的目的是了解在三级医疗医院就诊的患者中酒精消费模式及酒精性肝病（ARLD）的严重程度。方法 在卡拉奇齐亚丁医院克利夫顿院区开展了一项横断面研究。纳入在肝脏门诊就诊、肝酶异常且排除其他病因后有饮酒史的患者。进行了详细病史询问、常规检查、胰岛素水平检测、腹部超声检查及瞬时弹性成像检查。结果 本研究共纳入155例患者，其中98%为男性。中位年龄为45.93岁（范围：18 - 78岁）。就诊患者中略超过四分之三为穆斯林（n = 119；76.8%）。酒精摄入的中位时长为5.7年。所有患者均承认在晚餐前空腹饮酒。最常见的相关成瘾行为是吸烟（n = 95；61.2%）。约三分之二的患者承认有暴饮行为（n = 66；42.9%）。根据《精神疾病诊断与统计手册》标准，92例患者（59.35%）为酒精依赖。肝脂肪变性与患者体重呈正相关（p = 0.035）。与肝脂肪变性呈正相关的其他因素包括胰岛素抵抗（p = 0.031）、尿酸水平升高（p = 0.003）及酒精摄入量（p = 0.054）。73例（47.09%）患者存在显著纤维化（F3 - F4）。其与低血小板计数、总胆红素、天冬氨酸转氨酶、γ-谷氨酰转肽酶、碱性磷酸酶、国际标准化比值、白蛋白、尿酸、受控衰减参数及酒精摄入量相关，p值具有统计学意义。进一步的多变量分析显示肝纤维化与胆固醇水平相关，p值具有统计学意义（p = 0.045）。结论 在我们的人群中，酒精性肝病主要是男性主导的疾病。大多数患者大量饮用高浓度酒精且存在酒精依赖。相当数量的患者存在胰岛素抵抗。
