酒精性心肌病的发病机制与临床

Pathogenesis and Clinical Manifestations of Alcoholic Cardiomyopathy

随着生活水平的提高,酒精消费增多,长期大量饮酒所致的酒精性心肌病发病率也逐年上升。酒精性心肌病是一种以心脏扩大、心律失常及心功能不全为特点的非缺血性心肌病,诊断标准为平均每日乙醇摄入超过80 g并持续5年以上。多种机制参与酒精性心肌病的发生发展。磷脂酰乙醇胺可作为评估既往酒精摄入量的指标。早期患者可通过戒酒恢复心脏功能,出现症状者则需抗心律失常及抗心力衰竭治疗。目前对酒精性心肌病了解不够深入,而早期诊断及干预可改善预后。现将其发病机制、临床特点、诊断及治疗等做相关综述,以期帮助临床工作者提高对酒精性心肌病的认识。

The amount of alcohol consumption is getting larger with the improvement of living standards,and it has drawn greater attention that the morbidity of alcoholic cardiomyopathy （ACM） tends to increase. ACM is characterized by dilation of myocardial ventricles arrhythmia and cardiac insufficiency,along with a long history of alcohol abuse. Mechanisms may include oxidative stress, apoptotic cell death,impaired mitochondrial bioenergetics, derangements in fatty acid metabolism, and nutritional disturbance. Levels of phosphatidylethanols （PEth） in blood could be used as markers of previous alcohol consumption. Patients in early stage could recover by abstinence of alcohol, while others need treatment for heart failure and arhytlimia. The lack of knowledge to ACM makes early diagnosis and intervention difficult to achieve better prognosis. The aim of this review is to mainly describe the pathogenesis and clinical manifestations of ACM.