The clinical course of alcoholic cirrhosis: effects of hepatic metabolic capacity, alcohol consumption, and hyponatremia – a historical cohort study
The clinical course of alcoholic cirrhosis: effects of hepatic metabolic capacity, alcohol consumption, and hyponatremia – a historical cohort study
复制标题
酒精性肝硬化的临床过程：肝脏代谢能力、饮酒和低钠血症的影响——一项历史队列研究
作者：
P. Jepsen;P. Ott;P. Andersen;H. Vilstrup
研究背景：肝硬变并发症、肝性脑病、腹水和精索静脉曲张出血会增加死亡率，但发展顺序是随机的。因此，基于这些临床并发症的存在或不存在的预后本质上是不准确的，应该确定临床病程的其他决定因素。在这里，我们介绍了可能与酒精性肝硬变特定并发症的发生有关的病理因素的研究；它基于一个包括肝脏代谢能力、持续饮酒和循环功能障碍的肝硬变病理生理学模型。方法我们跟踪了丹麦社区的466名酒精性肝硬变患者。采用分层COX回归分析GEC(衡量肝脏代谢能力)、饮酒和血浆钠浓度(衡量循环功能障碍)对首次肝性脑病、首次腹水、首次静脉曲张出血和死亡率的影响。我们根据共病、性别和年龄调整了混杂因素。结果低GEC增加了首次发生肝性脑病的风险(风险比[HR]1.21/0.1 mmol/min GEC损失，95%可信区间1.11~1.31)，但与其他不良事件无关。饮酒增加首次腹水(HR 3.18，95%CI 1.19~8.47)、首次静脉曲张出血(HR 2.78，95%CI 1.59~4.87)和死亡率(HR 2.45，95%CI 1.63~3.66)的风险，但不增加首次肝性脑病的风险。低钠血症增加了所有不良事件的风险。结论肝脏代谢能力降低、饮酒和低钠血症与酒精性肝硬变的特殊并发症的发生有关。
BackgroundThe cirrhosis complications hepatic encephalopathy, ascites, and variceal bleeding increase mortality but develop in random sequence. Therefore prognoses based on the presence or absence of these clinical complications are inherently inaccurate, and other determinants of the clinical course should be identified. Here we present our study of patho-etiological factors that may be causally involved in the development of specific complications to alcoholic cirrhosis; it was based on a model of cirrhosis pathophysiology encompassing hepatic metabolic capacity, continued alcohol consumption, and circulatory dysfunction.MethodsWe followed a Danish community-based cohort of 466 patients with alcoholic cirrhosis. Stratified Cox regression was used to examine the effects of GEC (a measure of hepatic metabolic capacity), alcohol consumption, and plasma sodium concentration (a measure of circulatory dysfunction) on the hazard rates of first-time hepatic encephalopathy, first-time ascites, first-time variceal bleeding, and mortality. We adjusted for confounding by comorbidity, gender, and age. Data on risk factors and confounders were updated during follow-up.ResultsA low GEC increased the risk of first-time hepatic encephalopathy (hazard ratio [HR] 1.21 per 0.1 mmol/min GEC loss, 95% CI 1.11-1.31), but was unassociated with other adverse events. Alcohol consumption increased the risk of first-time ascites (HR 3.18, 95% CI 1.19-8.47), first-time variceal bleeding (HR 2.78, 95% CI 1.59-4.87), and mortality (HR 2.45, 95% CI 1.63-3.66), but not the risk of first-time hepatic encephalopathy. Hyponatremia increased the risk of all adverse events.ConclusionsReduced hepatic metabolic capacity, alcohol consumption, and hyponatremia were causally involved in the development of specific complications to alcoholic cirrhosis.
酒精与癌症。
影响因子：
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作者：
Rogers,AE;Conner,MW
通讯作者：
Conner,MW
DOI：
10.1056/nejmoa0801209
发表时间：
2008-09-04
期刊：
The New England journal of medicine
影响因子：
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作者：
Kim WR;Biggins SW;Kremers WK;Wiesner RH;Kamath PS;Benson JT;Edwards E;Therneau TM
通讯作者：
Therneau TM