Unit of Addiction and Hepatology, Alcohological Regional Center, IRCCS Ospedale Policlinico San Martino, ASL3, Genoa, Italy -
Italian Society on Alcohol (SIA), Bologna, Italy -
Panminerva Med. 2021 Sep;63(3):361-367. doi: 10.23736/S0031-0808.21.04272-5. Epub 2021 Jan 25.
Alcohol use disorders (AUDs) cause 80% of hepatotoxic-related deaths, and approximately 40% of cases of cirrhosis is due to alcohol. The relative risk of developing cirrhosis increases significantly for doses above 60 g/day for men and 20 g/day for women over a period of 10 years. Hence, there is a great opportunity to early detect both AUDs and liver disease, optimizing their management. Such strategy allows patients to be included in a detoxification program in order to achieve total abstinence. Nevertheless, it is crucial to highlight that a great part of patients hospitalized for the first time with cirrhosis or liver failure are not aware to have AUDs. This implies that most of them are diagnosed at an advanced stage. This is more serious considering that about 5% of cirrhotic patients develop hepatocellular carcinoma (HCC). Consequently, this malignancy is diagnosed late. Early detection of fibrosis, is a crucial step in patients with liver disease due to AUDs, influencing treatment and prognosis. Liver biopsy represents the gold standard to diagnose and to stage fibrosis. However, the main limitations of this approach are its invasiveness and its reduced representation of the histological picture. For these reasons, noninvasive methods have been introduced in the latest decade, being the main one elastography, which measure liver stiffness, a parameter directly correlated to liver fibrosis. In this review, we propose an algorithm for early identification of AUDs and liver disease, permitting to early identify HCC and to treat with alcohological programs these patients.
酒精使用障碍（AUD）导致 80%的肝毒性相关死亡，约 40%的肝硬化病例是由酒精引起的。男性每天摄入超过 60 克、女性每天摄入超过 20 克酒精超过 10 年，患肝硬化的相对风险显著增加。因此，早期发现 AUD 和肝病的机会很大，可以优化其管理。这种策略可以使患者接受解毒方案，以达到完全戒酒。然而，必须强调的是，首次因肝硬化或肝功能衰竭住院的患者中，有很大一部分不知道自己患有 AUD。这意味着他们中的大多数人在晚期才被诊断出来。考虑到约 5%的肝硬化患者会发展为肝细胞癌（HCC），这就更严重了。因此，这种恶性肿瘤被诊断得很晚。由于 AUD 导致的肝病患者中，早期检测纤维化是一个关键步骤，这会影响治疗和预后。肝活检是诊断和分期纤维化的金标准。然而，这种方法的主要局限性在于其侵袭性和对组织学图像的代表性不足。出于这些原因，非侵入性方法在过去十年中被引入，其中主要的方法是弹性成像，它测量肝脏硬度，这是一个与肝纤维化直接相关的参数。在这篇综述中，我们提出了一种早期识别 AUD 和肝病的算法，能够早期发现 HCC，并对这些患者进行酒精治疗方案。
