Bode J C, Kruse G, Mexas P, Martini G A
Dtsch Med Wochenschr. 1984 Oct 5;109(40):1516-21. doi: 10.1055/s-2008-1069404.
Drinking pattern as well as clinical, biochemical and histological findings were recorded of 282 males with alcohol-induced liver disease (fatty liver in 103, hepatitis in 61, cirrhosis in 118). The proportion of persons under 50 years of age was significantly greater with alcoholic hepatitis (70%) than cirrhosis (46%). Mean daily alcohol consumption was clearly lower among those with fatty liver than hepatitis or cirrhosis (P less than 0.02). Duration of alcohol abuse was on average shorter in patients with fatty liver and hepatitis than with cirrhosis (excessive consumption of less than 15 years was 61% and 62%, respectively, in the former, 28% in the latter (P less than 0.02). Symptoms and clinical and biochemical findings did not help in differentiating between hepatitis without cirrhotic change and cirrhosis. The most marked differences between cirrhosis and hepatitis, on one hand, and fatty liver, on the other, related to the frequency of certain signs and symptoms: upper abdominal pain, hard consistency of the liver, generalized jaundice, bleeding from esophageal varices and ascites; among biochemical findings they were: elevation of serum-bilirubin concentration above 34 mumol/l (2 mg/dl), lowering of the Quick values and of albumin concentration. Mortality rate during hospital stay was lower among patients with hepatitis but no cirrhotic change (6.6%) than among those with cirrhotic change (31.4%). While the prognosis under abstinence was relatively more favourable in patients with mild or moderately severe hepatitis, nonicteric forms require closer attention than has been given them so far.
记录了282例酒精性肝病男性患者的饮酒模式以及临床、生化和组织学检查结果(其中103例为脂肪肝,61例为肝炎,118例为肝硬化)。酒精性肝炎患者中50岁以下人群的比例(70%)显著高于肝硬化患者(46%)。脂肪肝患者的平均每日酒精摄入量明显低于肝炎或肝硬化患者(P<0.02)。脂肪肝和肝炎患者的酒精滥用持续时间平均短于肝硬化患者(前者饮酒超过15年的比例分别为61%和62%,后者为28%,P<0.02)。症状以及临床和生化检查结果无助于区分无肝硬化改变的肝炎和肝硬化。一方面,肝硬化和肝炎与另一方面的脂肪肝之间最显著的差异与某些体征和症状的出现频率有关:上腹部疼痛、肝脏质地坚硬、全身黄疸、食管静脉曲张出血和腹水;在生化检查结果方面,差异在于:血清胆红素浓度升高超过34μmol/l(2mg/dl)、奎克值降低和白蛋白浓度降低。无肝硬化改变的肝炎患者住院期间的死亡率(6.6%)低于有肝硬化改变的患者(31.4%)。虽然戒酒情况下轻度或中度重度肝炎患者的预后相对较好,但非黄疸型肝炎需要比目前给予更多的关注。