内蒙古通辽市酒精性肝炎临床诊断现状  

Clinical diagnosis of alcoholic hepatitis in Tongliao City,Inner Mongolia

作　　者：魏冬梅[1] 焦红波[1] 刘奕婷[2] 赵婧 韩白乙拉 佟静[3] 王炳元[3] Wei Dongmei;Jiao Hongbo;Liu Yiting;Zhao Jing;Hanbai Yila;Tong Jing;Wang Bingyuan(Department of Alcohol-related Liver Diseases,Tongliao Infectious Disease Hospital,Inner Mongolia,Tongliao 028000,China;Department of Physical Examination Center,the first A.ffiliated Hospital,ChnaMedical University.Shenyang 110001.China;Department of Gastroenterology.the First Affiliated Hospitalof China Medical University,Shenyang 110001,China)

机构地区：[1]通辽市传染病医院酒精性肝病科,028000 [2]中国医科大学附属第一医院体检中心,沈阳110001 [3]中国医科大学附属第一医院消化内科,沈阳110001

出　　处：《中华肝脏病杂志》2021年第9期861-866,共6页Chinese Journal of Hepatology

基　　金：国家青年自然科学基金(8170030364)。

摘　　要：目的探讨基层医生对酒精性肝炎诊断的现状。方法回顾性分析2018年6月1日至2019年5月31日,内蒙古通辽市传染病医院诊断明确的酒精(乙醇)相关性肝病住院患者的临床资料,按照美国国家酒精滥用和酒精中毒研究所推荐的酒精性肝炎诊断标准,对临床诊断的酒精性肝炎进行一致性判断,然后应用国际指南推荐的酒精性肝炎严重程度评估模型,包括Maddrey判别函数、终末期肝病模型、格拉斯哥酒精性肝炎评分和ABIC(年龄、总胆红素、国际标准化比值和肌酐)评分等对本组病例中的酒精性肝炎进行评估。结果 79例酒精(乙醇)相关性肝病患者中男性75例,女性4例;年龄27~75(51.1±8.8)岁;饮酒量(折合纯乙醇)60~600 g/d[(148.8±76.6)g/d];持续饮酒时间4~50年[(23.9±9.6)年]。按照出院第一诊断,酒精性肝炎组47例,酒精性肝硬化组32例。酒精性肝硬化组患者平均红细胞体积、血清丙氨酸转氨酶、天冬氨酸转氨酶和总胆红素均高于酒精性肝炎组患者,白蛋白、总胆固醇均低于酒精性肝炎患者,凝血指标也明显延长。尽管2组甲胎蛋白都在正常范围,但酒精性肝炎组显著高于酒精性肝硬化组。按照美国国家酒精滥用和酒精中毒研究所的酒精性肝炎定义,酒精性肝硬化组有10例患者满足酒精性肝炎的定义诊断,酒精性肝炎组为0例。符合酒精性肝炎诊断的10例患者中,达到Maddrey判别函数、终末期肝病模型、格拉斯哥酒精性肝炎评分和ABIC评分模型重症酒精性肝炎标准者,分别为5例、6例、1例和3例。终末期肝病模型评分>20分的6例患者在Maddrey判别函数、ABIC评分、格拉斯哥酒精性肝炎评分模型中分别为5例、1例和3例。结论临床医生对酒精性肝炎存在过度诊断,符合美国国家酒精滥用和酒精中毒研究所的诊断标准的酒精性肝炎患者均有肝硬化基础;终末期肝病模型评分>20分的患者与Maddrey判别函数模型�Objective To explore the current status of alcoholic hepatitis diagnosis by clinicians’in China.Methods Clinical data of inpatients confirmed with alcohol-associated liver disease diagnosed at Tongliao Infectious Disease Hospital of Inner Mongolia from June 1,2018 to May 31,2019 were retrospectively analyzed.The consistency of clinical diagnosis of alcoholic hepatitis was judged according to the diagnostic criteria recommended by the National Institute of Alcohol Abuse and Alcoholism(USA),and then the alcoholic hepatitis severity assessment model recommended by international guidelines,including Maddrey discriminant function.Model for end-stage liver disease,and Glasgow alcoholic hepatitis score and ABIC scores(age,total bilirubin,international normalized ratio and creatinine)were applied to evaluate this group of cases.Results Among 79 cases with alcohol-associated liver disease,75 were males and 4 were females,age ranged between 27〜75(51.1±8.8)years.Alcohol consumption varied from 60 g/d to 600g/d,with an average consumption of 148.8±76.6 g/d.The alcohol consumption duration ranged from 4 to 50[average(23.9±9.6)]years.According to the initial discharge diagnosis,there were 47 and 32 cases in alcoholic hepatitis and alcoholic liver cirrhosis group,respectively.The mean erythrocyte volume,serum alanine aminotransferase,aspartate aminotransferase and total bilirubin were increased in alcoholic liver cirrhosis than alcoholic hepatitis group,while albumin and total cholesterol were lowered in alcoholic liver cirrhosis than alcoholic hepatitis group,and coagulation indexes were significantly extended.Alpha-fetoprotein of both groups were in the normal range;however,it was significantly higher in the alcoholic hepatitis group than the alcoholic cirrhosis group.The 10 cases in the alcoholic cirrhosis group met the definition and diagnosis of alcoholic hepatitis defined by the National Institute of Alcohol Abuse and Alcoholism(USA),but there was no case in the alcoholic hepatitis group.Among the 10 diagnosed case

关 键 词：酒精性肝病 酒精性肝炎 酒精性肝硬化 诊断 

分 类 号：R575.5[医药卫生—消化系统]