Saunders J B, Walters J R, Davies A P, Paton A
Br Med J (Clin Res Ed). 1981 Jan 24;282(6260):263-6. doi: 10.1136/bmj.282.6260.263.
A total of 512 people from a defined population in west Birmingham served by a district general hospital were found to have cirrhosis in the period 1959-76. The annual incidence rose from 5.6 per 100 000 to a peak of 15.3 per 100 000 in 1974. This was due to an increase in the incidence of alcoholic cirrhosis, which in the last six years accounted for two-thirds of cases. The proportion of patients with decompensated cirrhosis when first seen (65%) did not alter during the 18 years. This was reflected in a death rate of 78% among the 468 patients traced up to the end of 1978. Liver failure, hepatoma, and gastrointestinal haemorrhage accounted for almost three-quarters of the deaths. The proportion of patients who survived for five years was 36% for alcoholic cirrhosis, 14% for cryptogenic cirrhosis, and 60% for chronic active hepatitis, and these figures too remained constant throughout the 18 years. Modern methods of treatment for decompensated cirrhosis did not improve prognosis and only abstention in patients with alcoholic cirrhosis had a beneficial effect on survival. Since alcoholic cirrhosis is now the most common form of the disease it is important to recognise those at risk and to encourage abstinence; also, more efforts are needed to identify the causes of cryptogenic cirrhosis. Whatever the cause, cirrhosis needs to be diagnosed before decompensation occurs, if treatment is to have any effect.
在1959年至1976年期间，一家地区综合医院所服务的伯明翰西部特定人群中，共有512人被发现患有肝硬化。年发病率从每10万人5.6例上升至1974年的峰值每10万人15.3例。这是由于酒精性肝硬化发病率上升所致，在过去六年中，酒精性肝硬化病例占三分之二。初诊时失代偿性肝硬化患者的比例（65%）在18年中没有变化。这反映在追踪至1978年底的468例患者中，死亡率为78%。肝衰竭、肝癌和胃肠道出血占死亡原因的近四分之三。酒精性肝硬化患者五年生存率为36%，隐源性肝硬化患者为14%，慢性活动性肝炎患者为60%，这些数字在18年中也保持不变。失代偿性肝硬化的现代治疗方法并未改善预后，只有酒精性肝硬化患者戒酒对生存有有益影响。由于酒精性肝硬化现在是该疾病最常见的形式，识别有风险的人群并鼓励戒酒很重要；此外，还需要更多努力来确定隐源性肝硬化的病因。无论病因如何，如果要使治疗有任何效果，肝硬化都需要在失代偿发生之前得到诊断。
