Yates W R, Labrecque D R, Pfab D
Department of Psychiatry, University of Oklahoma College of Medicine, Tulsa Campus, 74129-1077, USA.
Alcohol Alcohol. 1998 Sep-Oct;33(5):488-94. doi: 10.1093/alcalc/33.5.488.
Alcoholic liver disease is considered an indication for liver transplantation when a candidate is felt to have a high likelihood of abstinence following transplantation. Historical variables such as duration of sobriety, duration and quantity of drinking, and treatment history are commonly used to estimate alcoholism prognosis, yet their reliability and validity in patients with alcoholic cirrhosis has received limited study. Fifty subjects (9 women and 41 men) with alcoholic cirrhosis underwent an alcoholism history interview. Each subject had a collateral source (usually a spouse) who was interviewed by a second interviewer blind to the subject's alcoholism history. The two histories were compared for duration of abstinence in months and estimated alcoholism relapse risk was calculated using the High-risk Alcoholism Relapse scale (HRAR). Duration of sobriety correlated highly between subject and collateral source (Spearman r= 0.96, P = 0.0001) as did HRAR total score (Spearman r = 0.72, P = 0.0001). Categorical assignments also showed high correlations with duration of sobriety (kappa = 0.97) and HRAR category (kappa = 0.63). When disagreements were present, collateral sources tended to underestimate severity of alcoholism. We conclude that patients with alcoholic liver disease provide a reliable history for alcoholism variables when compared with a collateral source, and that, when disagreements are present, subjects tend to report a more acute or severe alcohol problem. The results support the clinical use of patient history information in making decisions about medical interventions for alcoholic liver disease.
当认为候选人在肝移植后有很高的戒酒可能性时，酒精性肝病被视为肝移植的指征。诸如戒酒持续时间、饮酒持续时间和饮酒量以及治疗史等历史变量通常用于估计酒精中毒的预后，然而它们在酒精性肝硬化患者中的可靠性和有效性研究有限。五十名患有酒精性肝硬化的受试者（9名女性和41名男性）接受了酒精中毒病史访谈。每个受试者都有一个旁证来源（通常是配偶），由对该受试者酒精中毒病史不知情的第二名访谈者进行访谈。比较了两人关于戒酒月数的病史，并使用高风险酒精中毒复发量表（HRAR）计算估计的酒精中毒复发风险。受试者与旁证来源之间的戒酒持续时间相关性很高（斯皮尔曼r = 0.96，P = 0.0001），HRAR总分也是如此（斯皮尔曼r = 0.72，P = 0.0001）。分类赋值与戒酒持续时间（kappa = 0.97）和HRAR类别（kappa = 0.63）也显示出高度相关性。当存在分歧时，旁证来源往往会低估酒精中毒的严重程度。我们得出结论，与旁证来源相比，酒精性肝病患者提供的酒精中毒变量病史可靠，并且当存在分歧时，受试者倾向于报告更急性或更严重的酒精问题。这些结果支持在对酒精性肝病进行医疗干预决策时临床使用患者病史信息。
