Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California; Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California.
Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California.
Gastroenterology. 2024 Jun;166(6):1156-1165.e4. doi: 10.1053/j.gastro.2024.02.032. Epub 2024 Feb 29.
BACKGROUND & AIMS: Conflicting data exist on the impact of alcohol use on risk of liver disease progression in patients with steatotic liver disease. We aimed to evaluate the effect of longitudinal alcohol use on risk of cirrhosis among veterans with steatotic liver disease.
US veterans with steatotic liver disease were identified from January 2010 through December 2022. Alcohol use was assessed using documented Alcohol Use Disorders Identification Test-Concise (AUDIT-C) scores and categorized as no alcohol (AUDIT-C = 0), low-risk alcohol use (AUDIT-C 1-2 for women and 1-3 for men), and high-risk alcohol (AUDIT-C ≥ 3 for women and ≥ 4 for men). Incidence of cirrhosis was evaluated with competing risks Nelson-Aalen methods. Adjusted multivariable regression models evaluated risks of cirrhosis associated with baseline alcohol use and changes in alcohol use during follow-up.
There were 1,156,189 veterans with steatotic liver disease identified (54.2% no alcohol, 34.6% low-risk alcohol, and 11.2% high-risk alcohol). Veterans with steatotic liver disease and high-risk alcohol have a 43% higher incidence of cirrhosis compared with patients reporting no alcohol use. Compared with patients with baseline high-risk alcohol who reported no change in alcohol use, those who decreased their alcohol use during follow-up experienced a 39% reduction in long-term risk of cirrhosis (hazard ratio, 0.61; 95% CI, 0.45-0.83; P < .01).
One in 9 veterans with steatotic liver disease report concurrent high-risk alcohol use, which is associated with 43% greater risk of cirrhosis compared with no alcohol use. However, reducing alcohol use lowers risk of cirrhosis, emphasizing the importance of timely alcohol use assessment and early interventions to address high-risk alcohol use in steatotic liver disease.
关于酒精使用对脂肪性肝病患者肝病进展风险的影响，现有数据相互矛盾。本研究旨在评估酒精使用对脂肪性肝病患者发生肝硬化的纵向影响。
从 2010 年 1 月至 2022 年 12 月，在美国退伍军人事务部数据库中识别出脂肪性肝病患者。使用记录的酒精使用障碍识别测试简明版（AUDIT-C）评分评估酒精使用情况，并将其分为无酒精（AUDIT-C=0）、低危酒精使用（女性 AUDIT-C 为 1-2，男性为 1-3）和高危酒精使用（女性 AUDIT-C≥3，男性 AUDIT-C≥4）。使用竞争风险 Nelson-Aalen 方法评估肝硬化的发生率。调整后的多变量回归模型评估了基线酒精使用和随访期间酒精使用变化与肝硬化风险的相关性。
共纳入 1156189 名脂肪性肝病患者（44.2%无酒精，34.6%低危酒精，11.2%高危酒精）。与报告无酒精使用的患者相比，高危酒精使用的脂肪性肝病患者肝硬化发生率高 43%。与报告基线高危酒精但酒精使用无变化的患者相比，随访期间减少酒精使用的患者肝硬化长期风险降低 39%（危险比，0.61；95%CI，0.45-0.83；P<.01）。
1/9 的脂肪性肝病退伍军人报告同时存在高危酒精使用，与无酒精使用相比，肝硬化风险增加 43%。然而，减少酒精使用可降低肝硬化风险，强调了及时评估酒精使用和早期干预以解决脂肪性肝病中高危酒精使用的重要性。
