长期饮酒者肝脏和胰腺早期损害状况和相关性

Early damage and correlation of liver and pancreas in long-term drinkers

目的:探讨长期饮酒者肝脏和胰腺早期功能和形态改变及相关性,以了解酒精对肝脏和胰腺的直接损害状况和机制。方法:根据2018年版酒精性肝病防治指南要求,选取2018年1月至2019年5月长期饮酒者门诊检查资料,均为男性,长期饮酒无肝脏损害者50例、轻度酒精性肝病患者43例,回顾性分析其淀粉酶、糖化血红蛋白,空腹血糖、餐后2 h血糖、空腹胰岛素、餐后2 h胰岛素、γ谷氨酰转肽酶、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆汁酸、胆红素等血生化指标和肝脏、胰腺形态影像学检查资料。结果:长期饮酒者无肝脏损害组50例,其中淀粉酶升高者13例、糖化血红蛋白升高10例,空腹血糖升高7例、餐后2 h血糖升高10例,空腹胰岛素升高者3例,餐后2 h胰岛素升高者2例,MRI发现胰腺增大3例、胰腺缩小1例、胰腺钙化1例、胰腺囊肿2例、胰管扩张2例。轻度酒精性肝病组43例,其中γ谷氨酰转肽酶者升高者33例、丙氨酸氨基转移酶升高36例,天门冬氨酸氨基转移酶升高24例,总胆汁酸升高27例,胆红素升高3例,MRI发现肝脏肿大者6例,淀粉酶升高者12例,糖化血红蛋白升高12例,空腹血糖升高5例、餐后2 h血糖升高8例,空腹胰岛素升高者3例,餐后2 h胰岛素升高者2例,MRI发现胰腺增大3例、胰腺缩小2例、胰腺钙化2例、胰腺囊肿1例、胰管扩张3例。两组之间的胰腺内外分泌功能血清指标(淀粉酶、糖化血红蛋白、空腹血糖、餐后2 h血糖、空腹胰岛素、餐后2 h胰岛素)经统计学分析,差异无统计学意义(P>0.05);两组均有不同程度的胰腺影像学改变(胰腺增大、钙化、缩小、扩张、囊肿),经Fisher精确概率法分析,差异均无统计学意义(P>0.05)。结论:长期饮酒不仅可对肝脏直接损害,对胰腺也可发生直接损害,在早期损害中肝脏和胰腺损害无明显相关性,酒精性肝病是一种以肝脏损害为主的全身性疾病。

Objective:To explore the early functional and morphological changes and correlations of liver and pancreas in long-term drinkers,to understand the direct damage and mechanism of alcohol to the liver and pancreas.Methods:According to the 2018 edition of the guidelines for the prevention and treatment of alcoholic liver disease,the information on the outpatient examinations of long-term drinkers from January 2018 to May 2019 in our hospital was selected.50 patients of long-term drinking without liver damage,43 patients of mild alcoholic liver disease.Retrospective analysis of amylase,glycated hemoglobin,fasting blood glucose,2 hours postprandial blood glucose,fasting insulin,2 hours postprandial insulin,gamma glutamyl transpeptidase,alanine aminotransferase,aspartate aminotransferase,total bile acid,bilirubin and other blood biochemical indicators and liver and pancreas morphology imaging data.Results:50 patients of long-term drinking without liver damage:13 patients'serum amylase elevated,10 patients'glycosylated hemoglobin A elevated,7 patients'fasting blood glucose increase,10patients'2 hours postprandial blood glucose increased,3 patients'fasting insulin level elevated,2 patients'2 hours postprandial insulin rised;MRI found 3 patients of enlarged pancreas,1 patient of pancreas shrink,1 patient of pancreatic calcification,2 patients'of pancreatic cyst,2 patients'of pancreatic duct dilatation.43 patients of mild alcoholic liver disease:33 patients gamma-glutamyl transpeptidase elevated,36 patient s'alanine aminotransferase elevated,24 patient s'Aspartate aminotransferase alanine elevated,27 patients'total bile acid elevated,3 patients'bilirubin elevated,12 patients'serum amylase elevated,12 patients'glycosylated hemoglobin A elevated,5 patients'fasting blood-glucose increase,8 patients'2 hours postprandial blood glucose increased,3 patients'fasting insulin level elevated,2 patients'2 hours postprandial insulin rised.MRI found 3 patients of enlarged pancreas,2 patient of pancreas shrink,2 patient of pancreatic calcification,1 patients'of pancreatic cyst,3 patients'of pancreatic duct dilatation,6 patients of liver enlargement.Serum indicators of pancreatic endocrine and exocrine function(amylase,glycosylated hemoglobin,fasting blood glucose,2 hours postprandial blood glucose,fasting insulin,2 hours postprandial insulin)between the two groups were statistically analyzed,the difference was not statistically significant(P>0.05).There were different degrees of pancreatic imaging changes(pancreas enlargement,calcification,reduction,dilatation,cyst)in both groups.After Fisher's exact probability analysis,the difference was not statistically significant(P>0.05).Conclusions:Long-term drinking can cause direct damage to the liver and pancreas,but there is no significant correlation between liver and pancreatic damage in early damage.Alcoholic liver disease is a systemic disease characterized by liver damage.