酒精性肝病的随访(附28例11～17年随访)

Follow-up of alcoholic liver disease (a 28 case study of 11～17 years)

目的观察ALD的远期预后。方法经统一发信及笔者前往一个专区用电话向患者单位及到生存者家中随访。结果仅获得有反馈信息者28例,占随访病例之20.6%,其中已死亡12人,占有信息病例之42.9%。仅2例再获14年后肝穿活检对比。按2006年2月中华医学会肝脏病学分会脂肪肝和酒精性肝病学组修订诊断标准。①轻症ALD41人获4人复信均健在。②酒精性脂肪肝(AFL)15例有1人复信,继续饮酒(精)100g/d,12年后两次脑出血,已偏瘫。③酒精性肝炎(AH)24例,获信息反馈7例,其中2例已死于肝硬化,另3例已肝硬化,此型最终多合并糖尿病。④45例酒精性肝纤维化(AF)有反馈信息者11例,其中7例已死亡。⑤酒精性肝硬化(AC)11例,有反馈信息者5例,其中3例已死亡。结论轻症ALD远期预后较好。AFL如不戒酒远期效果差,AH、AF预后不良凶险。ALD合并ABV/HCV感染者远期预后不佳,多发展为肝硬化,合并肝癌死亡。

Objectives To observe the prognosis of alcoholic liver disease. Methods Patients were investigated by mail, telephone and visiting patient. Results Feedback was gotten from 28 patients, accounting for 20.6% of all poll. There were 12 patients died, accounting for 42.9% of all respondents. Liver biopsy was compared with 14 years ago in 2 cases. The diagnostic criteria made by Fatty Liver and Alcoholic Liver Disease Research Group of Hepatology Branch of Chinese Medical Association （2006） was applied in this observation. Four cases of mild alcoholic liver disease still were alive （4/41 ,alive）, 1 case of AFL（ 1/15, consuming alcohol 100g/d, intracerebral hemorrhage after 12 years and now with hemiplegia） ,7 cases of AH（7/24,2 of them died of cirrhosis and 3 alive with cirrhosis）, 11 of AF（ 11/45,7 of them died） and 5 of AC （5/11,3 of them died） were followed up in this period. Conclusions Prognostic of AH and AF are worse. ALD accompanied with HBV or HCV has worse long term prognostic,and most of them will progress to cirrhosis and live cancer. AFL without abstience of alcohol also has bad results.