GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK.
J Mol Med (Berl). 2022 Dec;100(12):1673-1689. doi: 10.1007/s00109-022-02254-8. Epub 2022 Oct 10.
Alcohol-associated liver disease (ALD) is one of the most common chronic liver diseases. Its pathological spectrum includes the overlapping stages of hepatic steatosis/steatohepatitis that can progress to liver fibrosis and cirrhosis; both are risk factors for hepatocellular carcinoma. Moreover, ALD diagnosis and management pose several challenges. The early pathological stages are reversible by alcohol abstinence, but these early stages are often asymptomatic, and currently, there is no specific laboratory biomarker or diagnostic test that can confirm ALD etiology. Alcohol consumers frequently show dysregulation of iron and iron-related proteins. Examination of iron-related parameters in this group may aid in early disease diagnosis and better prognosis and management. For this, a coherent overview of the status of iron and iron-related proteins in alcohol consumers is essential. Therefore, here, we collated and reviewed the alcohol-induced alterations in iron and iron-related proteins. Reported observations include unaltered, increased, or decreased levels of hemoglobin and serum iron, increments in intestinal iron absorption (facilitated via upregulations of duodenal divalent metal transporter-1 and ferroportin), serum ferritin and carbohydrate-deficient transferrin, decrements in serum hepcidin, decreased or unaltered levels of transferrin, increased or unaltered levels of transferrin saturation, and unaltered levels of soluble transferrin receptor. Laboratory values of iron and iron-related proteins in alcohol consumers are provided for reference. The causes and mechanisms underlying these alcohol-induced alterations in iron parameters and anemia in ALD are explained. Notably, alcohol consumption by hemochromatosis (iron overload) patients worsens disease severity due to the synergistic effects of excess iron and alcohol.
酒精相关性肝病（ALD）是最常见的慢性肝病之一。其病理谱包括肝脂肪变性/肝炎重叠阶段，可进展为肝纤维化和肝硬化；两者都是肝细胞癌的危险因素。此外，ALD 的诊断和管理存在一些挑战。通过戒酒可以逆转早期病理阶段，但这些早期阶段通常无症状，目前没有特定的实验室生物标志物或诊断试验可以确认 ALD 的病因。酒精消费者经常表现出铁和铁相关蛋白的失调。检查该人群的铁相关参数可能有助于早期疾病诊断、改善预后和管理。为此，对酒精消费者中铁和铁相关蛋白的状况进行全面综述是必要的。因此，在这里，我们对酒精引起的铁和铁相关蛋白的改变进行了整理和综述。报告的观察结果包括血红蛋白和血清铁水平不变、增加或减少，肠道铁吸收增加（通过上调十二指肠二价金属转运蛋白-1 和铁蛋白），血清铁蛋白和糖缺乏转铁蛋白增加，血清铁调素减少或不变，转铁蛋白水平降低或不变，转铁蛋白饱和度增加或不变，可溶性转铁蛋白受体水平不变。为参考提供了酒精消费者的铁和铁相关蛋白的实验室值。解释了这些酒精引起的铁参数改变和 ALD 贫血的原因和机制。值得注意的是，酒精摄入会使血色病（铁过载）患者的病情恶化，因为过量铁和酒精的协同作用。
