饮酒量对酒精性肝硬化食管胃静脉曲张患者肝功能及再出血的影响

Influence of alcohol consumption on liver function and rebleeding in alcoholic cirrhotic patients with esophageal and gastric varices

目的明确饮酒量对酒精性肝硬化患者肝功能及预后的影响。方法选取首都医科大学附属北京地坛医院消化内科自2008年9月-2018年12月因酒精性肝硬化伴食管胃静脉曲张破裂出血并行内镜下治疗患者211例,男208例,女3例,平均随访时间45(2~110)个月。将患者的饮酒情况与其肝功能指标进行相关性分析,根据患者是否发生食管胃静脉曲张再出血进行分组:早期再出血组、迟发性出血组和无再出血组,比较各组患者的肝功能指标与饮酒情况的差异。符合正态分布的计量资料组间比较采用t检验;非正态分布的计量资料组间比较采用Wilcoxon秩和检验。计数资料组间比较采用χ^2检验。Spearman秩相关进行相关性分析。结果饮酒持续时间与肌酐(r=0.142,P=0.039)、DBil(r=-0.137,P=0.047)呈相关性,每日饮酒量与DBil(r=0.144,P=0.037)、前白蛋白(r=-0.190,P=0.009)呈相关性,而总饮酒量与肝损伤指标均无任何相关性。早期再出血组和迟发性再出血组患者中WBC(t=-2.355,P=0.020)、中性粒细胞(t′=-2.602,Z=0.010)、Hb(t=2.247,P=0.026)、平均红细胞体积(t=-2.073,P=0.040)、ALT(Z=-1.985,Z=0.047)、INR(Z=-2.397,Z=0.017)、脾厚(Z=-2.542,P=0.011)、Child-Pugh评分(t′=-2.364,P=0.020)及分级(Z=-2.485,P=0.013)存在统计学差异。无再出血组患者的WBC(Z=-2.276,P=0.017)及中性粒细胞(Z=-2.375,P=0.018)均低于有再出血组。有再出血组患者的饮酒时间反而低于无再出血组患者(Z=-2.522,P=0.012)。Logistic回归分析结果显示,中性粒细胞为静脉曲张再出血的危险因素(比值比=1.152,95%可信区间:1.017~1.300,P=0.026)。结论本研究未能发现饮酒与肝损伤存在量效关系,饮酒对再出血的影响亦不明确。

Objective To investigate the influence of alcohol consumption on liver function and prognosis in alcoholic cirrhotic patients.Methods A total of 211 alcoholic cirrhotic patients with gastroesophageal variceal bleeding who underwent endoscopic treatment in Beijing Ditan Hospital,Capital Medical University,from September to December,2018 were enrolled,and among these patients,there were 208 male and 3 female patients,with a mean follow-up time of 45 months(range 2-110 months).The association of alcohol consumption with liver parameters was analyzed.According to the presence or absence of gastroesophageal variceal rebleeding,the patients were divided into early rebleeding group,delayed rebleeding group,and non-rebleeding group,and the three groups were compared in terms of liver parameters and alcohol consumption.The t-test was used for comparison of normally distributed continuous data between groups,and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups;the chi-square test was used for comparison of categorical data between groups.The Spearman rank correlation test was used for correlation analysis.Results Duration of drinking was correlated with creatinine(r=0.142,P=0.039)and direct bilirubin(DBil)(r=-0.137,P=0.047),and daily alcohol consumption was correlated with DBil(r=0.144,P=0.037)and prealbumin(r=-0.190,P=0.009),while there was no correlation between total alcohol consumption and indicators for liver injury.There were significant differences between the early rebleeding group and the delayed rebleeding group in white blood cell count(WBC)(t=-2.355,P=0.020),neutrophils(t′=-2.602,P=0.010),hemoglobin(t=2.247,P=0.026),mean corpuscular volume(t=-2.073,P=0.040),alanine aminotransferase(Z=-1.985,P=0.047),international normalized ratio(Z=-2.397,P=0.017),spleen thickness(Z=-2.542,P=0.011),Child-Pugh score(t′=-2.364,P=0.020),and Child-Pugh grade(Z=-2.485,P=0.013).The non-rebleeding group had significantly lower WBC(Z=-2.276,P=0.017)and neutrophils(Z=-2.375,P=0.018)than the rebleeding group,and the early and delayed rebleeding groups had a significantly shorter duration of drinking than the non-rebleeding group(Z=-2.522,P=0.012).The logistic regression analysis showed that neutrophils was a risk factor for variceal rebleeding(odds ratio=1.152,95%confidence interval:1.017-1.300,P=0.026).Conclusion No dose-response relationship is found between alcohol consumption and liver injury in this study,and alcohol consumption may not have a marked effect on variceal rebleeding.