乙醇对慢性丙型病毒性肝炎患者临床转归的影响  

Impact of Alcohol Drinking on the Clinical Progression and Outcome of Patients with Chronic Hepatitis C

作　　者：单媛[1] 霍娜[1] 张爱秋[2] 王力芬[1] 陆海英[1] 徐小元[1] 

机构地区：[1]北京大学附属第一医院感染疾病科 [2]河北省玉田县医院感染疾病科

出　　处：《首都医科大学学报》2009年第6期795-798,共4页Journal of Capital Medical University

基　　金：国家十一五重大专项(2008ZX10002-013);国家自然科学基金(30771906)资助项目~~

摘　　要：目的研究乙醇对慢性丙型病毒性肝炎患者临床转归的影响。方法回顾性对比分析非饮酒与饮酒的慢性丙型病毒性肝炎患者在临床表现、病毒学、预后方面的差异。结果162例慢性丙型病毒性肝炎病人中,非饮酒者99例,少量饮酒者34例,大量饮酒者29例,3者的病程中位数分别为12、9、8年,差异有统计学意义(P=0.005)。非饮酒者的谷丙转氨酶(alanine transam inase,ALT)、谷草转氨酶(aspartate transam inase,AST)、γ-谷氨酰转移酶(gamma-glutamyl transferase,GGT)、总胆红素(total bilirubin,TBIL)、平均红细胞容积(mean corpuscular volume,MCV)与少量饮酒及大量饮酒患者相比差异有统计学意义(P<0.05)。大量饮酒者中,高病毒载量患者的比例明显高于非饮酒者,差异有统计学意义(分别为31.0%和14.1%,P=0.037)。非饮酒者中肝硬化32例(32.3%),少量饮酒者为13例(43.3%),大量饮酒者为18例(62.1%),差异有统计学意义(P=0.015)。非饮酒者中死亡2例(4.0%),少量饮酒者死亡2例(5.9%),大量饮酒者死亡5例(17.2%),差异有统计学意义(P=0.000)。非饮酒者与饮酒者肝癌的发生率差异无统计学意义。结论饮酒可加重慢性丙型病毒性肝炎患者肝损害,加速病情的进展,增加肝硬化的发生率及病死率;大量饮酒有可能促进丙型肝炎病毒(hepatitis C virus,HCV)的复制。Objective To determine the impact of alcohol use on the clinical progression and outcome in patients with hepatitis C virus（HCV） infection. Methods A retrospective comparative analysis was performed in alcohol non-drinkers and drinkers to assess the variations of chronic hepatitis C patients in the clinical tests,virology,and prognosis. Results A total of 162 patients were enrolled. Of these,99 were non-drinkers,34 were mild drinkers,and 29 were heavy drinkers. The median clinical course of disease of the 3 groups were 12 years,9 years,and 8 years（P=0.005）. The test results of alanine transaminase（ALT）,aspartate transaminase（AST）,gamma-glutamyl transferase（GGT）,total bilirubin（TBIL） and mean corpuscular volume（MCV） had a significant difference between non-drinkers and mild or severe drinkers （P〈0.05）. There was a higher rate of high HCV-RNA load in heavy drinkers compared with the non-drinkers（31.0% and 14.1%,P=0.037）. Cirrhosis was proved 32.3%（32 persons） in non-drinkers,43.3%（13 persons） in mild drinkers,and 62.1%（18 persons） in heavy drinkers（P=0.015）. The mortality rate was 4.0%（2 persons） in non-drinkers,5.9%（2 persons） in mild drinkers,and 17.2%（5 persons） in heavy drinkers（P=0.000）. However,there was no significant difference on the morbidity of liver cancer between non-drinkers and drinkers. Conclusion Alcohol consumption could aggravate the hepatic lesions,accelerate the clinical progression,and increase the morbidity and mortality of cirrhosis in chronic HCV patients. In addition,large amount of alcohol consumption may increase HCV replication.

关 键 词：慢性丙型病毒性肝炎 乙醇 肝损害 肝硬化 肝癌 饮酒 统计学意义 临床转归 肝炎患者 慢性丙型肝炎 

分 类 号：R512.63[医药卫生—内科学]