Wei D M, Jiao H B, Liu Y T, Zhao J, Hanbai B Y L, Tong J, Wang B Y
Department of Alcohol-related Liver Diseases, Tongliao Infectious Disease Hospital, Inner Mongolia, Tongliao 028000, China.
Department of Physical Examination Center, the first Affiliated Hospital, China Medical University, Shenyang 110001, China.
Zhonghua Gan Zang Bing Za Zhi. 2021 Sep 20;29(9):861-866. doi: 10.3760/cma.j.cn501113-20200423-00206.
To explore the current status of alcoholic hepatitis diagnosis by clinicians' in China. Clinical data of inpatients confirmed with alcohol-associated liver disease diagnosed at Tongliao Infectious Disease Hospital of Inner Mongolia from June 1, 2018 to May 31, 2019 were retrospectively analyzed. The consistency of clinical diagnosis of alcoholic hepatitis was judged according to the diagnostic criteria recommended by the National Institute of Alcohol Abuse and Alcoholism (USA), and then the alcoholic hepatitis severity assessment model recommended by international guidelines, including Maddrey discriminant function, Model for end-stage liver disease, and Glasgow alcoholic hepatitis score and ABIC scores (age, total bilirubin, international normalized ratio and creatinine) were applied to evaluate this group of cases. Among 79 cases with alcohol-associated liver disease, 75 were males and 4 were females, age ranged between 27~75 (51.1±8.8) years. Alcohol consumption varied from 60 g/d to 600g/d, with an average consumption of 148.8 ± 76.6 g/d. The alcohol consumption duration ranged from 4 to 50 [average (23.9 ± 9.6)] years. According to the initial discharge diagnosis, there were 47 and 32 cases in alcoholic hepatitis and alcoholic liver cirrhosis group, respectively. The mean erythrocyte volume, serum alanine aminotransferase, aspartate aminotransferase and total bilirubin were increased in alcoholic liver cirrhosis than alcoholic hepatitis group, while albumin and total cholesterol were lowered in alcoholic liver cirrhosis than alcoholic hepatitis group, and coagulation indexes were significantly extended. Alpha-fetoprotein of both groups were in the normal range; however, it was significantly higher in the alcoholic hepatitis group than the alcoholic cirrhosis group. The 10 cases in the alcoholic cirrhosis group met the definition and diagnosis of alcoholic hepatitis defined by the National Institute of Alcohol Abuse and Alcoholism (USA), but there was no case in the alcoholic hepatitis group. Among the 10 diagnosed cases of alcoholic hepatitis, 5, 6, 1 and 3 cases met the diagnostic criteria of Maddrey discriminant function, Model for end-stage liver disease, Glasgow alcoholic hepatitis score, and ABIC score for severe alcoholic hepatitis, respectively. The Maddrey discriminant function, ABIC score, and Glasgow alcoholic hepatitis score within the Model for end-stage liver disease scores> 20 points had 5, 1, and 3 cases, respectively. Alcoholic hepatitis is over-diagnosed by clinicians. Alcoholic hepatitis patients have the base of liver cirrhosis who meet the diagnostic criteria of National Institute of Alcohol Abuse and Alcoholism (USA). Patients with Model for end-stage liver disease score > 20 points have good consistency with Maddrey discriminant function score ≥ 32 points, and both can be used to evaluate the alcoholic hepatitis patient clinical severity.
为探究我国临床医生对酒精性肝炎的诊断现状。回顾性分析2018年6月1日至2019年5月31日在内蒙古通辽市传染病医院确诊为酒精性肝病的住院患者的临床资料。根据美国国立酒精滥用与酒精中毒研究所推荐的诊断标准判断酒精性肝炎临床诊断的一致性,然后应用国际指南推荐的酒精性肝炎严重程度评估模型,包括Maddrey判别函数、终末期肝病模型、格拉斯哥酒精性肝炎评分和ABIC评分(年龄、总胆红素、国际标准化比值和肌酐)对该组病例进行评估。在79例酒精性肝病患者中,男性75例,女性4例,年龄在27~75(51.1±8.8)岁之间。酒精摄入量从60g/d至600g/d不等,平均摄入量为148.8±76.6g/d。饮酒时长为4至50[平均(23.9±9.6)]年。根据初次出院诊断,酒精性肝炎组和酒精性肝硬化组分别有47例和32例。酒精性肝硬化组的平均红细胞体积、血清丙氨酸氨基转移酶、天冬氨酸氨基转移酶和总胆红素高于酒精性肝炎组,而酒精性肝硬化组的白蛋白和总胆固醇低于酒精性肝炎组,凝血指标明显延长。两组甲胎蛋白均在正常范围内;然而,酒精性肝炎组明显高于酒精性肝硬化组。酒精性肝硬化组的10例患者符合美国国立酒精滥用与酒精中毒研究所定义的酒精性肝炎的定义和诊断,但酒精性肝炎组无病例。在10例诊断为酒精性肝炎的病例中,分别有5例、6例、1例和3例符合Maddrey判别函数、终末期肝病模型、格拉斯哥酒精性肝炎评分和重度酒精性肝炎ABIC评分的诊断标准。终末期肝病模型评分中Maddrey判别函数、ABIC评分和格拉斯哥酒精性肝炎评分>20分的分别有5例、1例和3例。临床医生对酒精性肝炎存在过度诊断。酒精性肝炎患者有符合美国国立酒精滥用与酒精中毒研究所诊断标准的肝硬化基础。终末期肝病模型评分>20分的患者与Maddrey判别函数评分≥32分具有良好的一致性,均可用于评估酒精性肝炎患者的临床严重程度。