背景与目的；非酒精性脂肪性肝病（NAFLD）是一种心血管危险因素，虽然适度饮酒可以降低心血管死亡风险，但是否NAFLD患者允许适度饮酒仍然是尚未解决的重要问题，我们的目的是在NAFLD患者中评估适度饮酒与非酒精性脂肪性肝炎(NASH)之间的关系。方法； 横断面分析美国国立卫生学院NASH临床研究网络的成人参与者，仅涉及适度饮酒或未饮酒者，具有（1）饮酒>20g/天，(2) 酗酒或(3)现今未饮酒但既往有饮酒史的患者均被排除在研究之外，使用多因素逻辑回归分析具有NASH组织学诊断和NAFLD其它组织学特征的几率。 结果；研究包括251例始终未饮酒者和331例适度饮酒者，与未饮酒者比较，适度饮酒者具有NASH诊断的几率更低(OR 0.56, 95% CI 0.39-0.84, P=0.002)。在适度的饮酒范围内，随饮酒次数的增加，NASH几率降低。与始终未饮酒者比较，适度饮酒者纤维化(OR 0.56 95% CI 0.41-0.77)和气球样肝细胞损害(OR 0.66 95% CI 0.48-0.92)的几率也显著降低。结论；本项大样本活检证实为NAFLD的人群显示，适度饮酒者疾病严重程度较轻，这是由于组成脂肪性肝炎诊断的主要特征以及纤维化几率较低，这些发现证实在NAFLD饮酒推荐中还需要前瞻性研究以及协调共识。
Modest alcohol consumption is associated with decreased prevalence of steatohepatitis in patients with non-alcoholic fatty liver disease (NAFLD).
BACKGROUND &AIMS: Non-alcoholic fatty liver disease (NAFLD) is a cardiovascular risk factor. Although modest alcohol consumption may reduce the risk for cardiovascular mortality, whether patients with NAFLD should be allowed modest alcohol consumption remains an important unaddressed issue. We aimed to evaluate the association between modest alcohol drinking and non-alcoholic steatohepatitis (NASH), among subjects with NAFLD. METHODS: In a cross-sectional analysis of adult participants in the NIH NASH Clinical Research Network, only modest or non-drinkers were included: participants identified as (1) drinking >20 g/day, (2) binge drinkers, or (3) non-drinkers with previous alcohol consumption were excluded. The odds of having a histological diagnosis of NASH and other histological features of NAFLD were analyzed using multiple ordinal logistic regression. RESULTS: The analysis included 251 lifetime non-drinkers and 331 modest drinkers. Modest drinkers compared to non-drinkers had lower odds of having a diagnosis of NASH (summary odds ratio 0.56, 95% CI 0.39-0.84, p=0.002). The odds of NASH decreased as the frequency of alcohol consumption increased within the range of modest consumption. Modest drinkers also had significantly lower odds for fibrosis (OR 0.56 95% CI 0.41-0.77) and ballooning hepatocellular injury (OR 0.66 95% CI 0.48-0.92) than lifetime non-drinkers. CONCLUSIONS: In a large, well-characterized population with biopsy-proven NAFLD, modest alcohol consumption was associated with lesser degree of severity as determined by lower odds of the key features that comprise a diagnosis of steatohepatitis, as well as fibrosis. These findings demonstrate the need for prospective studies and a coordinated consensus on alcohol consumption recommendations in NAFLD.
江西省景德镇市第三人民医院消化内科 杨力 摘译
本文首次发表于[J Hepatol. 2012 ,57(2):384-91]
本文首次发表于[J Hepatol. 2012 ,57(2):384-91]
Modest alcohol consumption is associated with decreased prevalence of steatohepatitis in patients with non-alcoholic fatty liver disease (NAFLD).
BACKGROUND &AIMS: Non-alcoholic fatty liver disease (NAFLD) is a cardiovascular risk factor. Although modest alcohol consumption may reduce the risk for cardiovascular mortality, whether patients with NAFLD should be allowed modest alcohol consumption remains an important unaddressed issue. We aimed to evaluate the association between modest alcohol drinking and non-alcoholic steatohepatitis (NASH), among subjects with NAFLD. METHODS: In a cross-sectional analysis of adult participants in the NIH NASH Clinical Research Network, only modest or non-drinkers were included: participants identified as (1) drinking >20 g/day, (2) binge drinkers, or (3) non-drinkers with previous alcohol consumption were excluded. The odds of having a histological diagnosis of NASH and other histological features of NAFLD were analyzed using multiple ordinal logistic regression. RESULTS: The analysis included 251 lifetime non-drinkers and 331 modest drinkers. Modest drinkers compared to non-drinkers had lower odds of having a diagnosis of NASH (summary odds ratio 0.56, 95% CI 0.39-0.84, p=0.002). The odds of NASH decreased as the frequency of alcohol consumption increased within the range of modest consumption. Modest drinkers also had significantly lower odds for fibrosis (OR 0.56 95% CI 0.41-0.77) and ballooning hepatocellular injury (OR 0.66 95% CI 0.48-0.92) than lifetime non-drinkers. CONCLUSIONS: In a large, well-characterized population with biopsy-proven NAFLD, modest alcohol consumption was associated with lesser degree of severity as determined by lower odds of the key features that comprise a diagnosis of steatohepatitis, as well as fibrosis. These findings demonstrate the need for prospective studies and a coordinated consensus on alcohol consumption recommendations in NAFLD.
