DETERMINANTS OF PROGRESSION TO CIRRHOSIS OR FIBROSIS IN PURE ALCOHOLIC FATTY LIVER
DETERMINANTS OF PROGRESSION TO CIRRHOSIS OR FIBROSIS IN PURE ALCOHOLIC FATTY LIVER
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DOI：
10.1016/s0140-6736(95)91685-7
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发表时间：
1995-10-14
期刊：
影响因子：
168.9
通讯作者：
JAMES, OFW
中科院分区：
文献类型：
--
作者：
TELI, MR;DAY, CP;JAMES, OFW
“纯”酒精性脂肪肝被广泛认为是“良性”的，进展为肝硬化的风险非常低。迄今为止的研究要么包括同时存在公认的肝硬化前期病变的患者，要么仅限于短期组织学随访。我们对 88 名患者进行了随访，这些患者于 1978 年至 1985 年间首次就诊，组织学诊断为纯酒精性脂肪肝，没有纤维化或酒精性肝炎的证据，中位时间为 10.5 年，以确定任何预测疾病进展的因素。在随访的 88 名患者中，有 9 名出现肝硬化，另外 7 名出现纤维化。随访时，9 名肝硬化患者中有 8 名每周持续饮酒超过 40 单位；其他患者的消耗情况未知。索引活检进展的独立组织学预测因素是：存在混合的大/微泡脂肪，以及存在巨大线粒体。我们不能再将酒精性脂肪肝视为良性。在持续大量饮酒的情况下，上述组织学特征确定了那些处于疾病进展高风险（47-61%）的人。因此，应就饮酒情况向具有这些特征的患者提供深入的咨询。
''Pure'' alcoholic fatty liver has been widely assumed to be ''benign'' with very low risk of progression to cirrhosis. Studies thus far have included either patients with coexisting recognised precursor lesions of cirrhosis or have been restricted to short-term histological follow-up. We have followed 88 patients, first seen between 1978 and 1985, with a histological diagnosis of pure alcoholic fatty liver and no evidence of fibrosis or alcoholic hepatitis, for a median of 10.5 years, to determine any factors predictive of disease progression.Of the 88, at follow-up nine had developed cirrhosis and a further seven fibrosis. Eight of nine patients with cirrhosis had continuing alcohol consumption of more than 40 units per week at follow-up; in the other patients, consumption was unknown. Independent histological predictors of progression on index biopsy were: presence of mixed macro/microvesicular fat, and presence of giant mitochondria.We can no longer regard alcoholic fatty liver as benign. in the presence of continuing high alcohol consumption the above histological features identified those at high risk (47-61%) of disease progression. Therefore, patients with these features should be counselled intensively regarding their alcohol consumption.