Liver Unit, Hospital Clínic, Barcelona, Spain.
Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Barcelona, Spain.
Liver Int. 2021 Jul;41(7):1556-1564. doi: 10.1111/liv.14830. Epub 2021 Mar 11.
Alcohol and metabolic syndrome (MS) coexist frequently as cofactors of liver disease. Previous studies suggest a deleterious effect of MS in advanced alcohol-related liver disease (ArLD). However, it is unknow whether MS can increase the risk of liver fibrosis in early stages of ArLD. The aim of this study was to investigate the effect of MS on liver fibrosis in subjects with alcohol consumption from a population-based cohort.
The number of subjects include 1760(58%) of 3014 who were randomly selected from the community consumed alcohol and were classified as current drinkers, divided in moderate (n = 1222) or high-risk drinkers (n = 275) (>21 units/week men, >14 units/week women for high-risk drinkers), or former drinkers (n = 263). Liver fibrosis was estimated by measuring liver stiffness(LS) with transient elastography (TE).
Prevalence of significant LS using cutoff values of TE of 8 and 9.1kPa was increased in high-risk compared with moderate or former drinkers and lifetime abstainers. In subjects with alcohol consumption, LS was associated with male gender, AST, ALT, years of consumption, and MS. In high-risk drinkers, MS and intensity of consumption were the only factors associated with significant LS (OR 3.7 and 4.6 for LS ≥ 8 kPa and 3.9 and 9.2 kPa for LS ≥ 9.1 kPa, respectively). Presence of significant liver fibrosis in the liver biopsy was higher among high-risk as compared with moderate or former drinkers.
MS increases the risk of liver fibrosis in subjects with alcohol consumption. Among high-risk drinkers, only MS and consumption of high amount of alcohol are associated with risk of liver fibrosis.
酒精和代谢综合征（MS）常同时存在，是肝病的重要因素。既往研究提示 MS 在晚期酒精性肝病（ArLD）中具有有害作用。但是，MS 是否会增加 ArLD 早期肝纤维化的风险尚不清楚。本研究旨在通过人群队列研究，探讨 MS 对酒精性肝病患者肝纤维化的影响。
从社区随机抽取 3014 名饮酒者中的 1760 名（58%）作为研究对象，分为当前饮酒者（分为适度饮酒者（n=1222）和高风险饮酒者（>21 单位/周男性，>14 单位/周女性））和既往饮酒者（n=263）。采用瞬时弹性成像（TE）测量肝硬度（LS）来评估肝纤维化。
与适度饮酒者或既往饮酒者和终身戒酒者相比，高风险饮酒者的 TE 截断值为 8kPa 和 9.1kPa 时，出现明显 LS 的比例更高。在有饮酒史的人群中，LS 与男性、AST、ALT、饮酒年限和 MS 相关。在高风险饮酒者中，MS 和饮酒量是与明显 LS 相关的唯一因素（LS≥8kPa 的 OR 分别为 3.7 和 4.6，LS≥9.1kPa 的 OR 分别为 3.9 和 9.2）。与适度饮酒者或既往饮酒者相比，高风险饮酒者中肝活检存在明显肝纤维化的比例更高。
MS 增加了有饮酒史者发生肝纤维化的风险。在高风险饮酒者中，只有 MS 和大量饮酒与肝纤维化风险相关。
