基础研究 Open Access
Copyright ©The Author(s) 2003. Published by Baishideng Publishing Group Inc. All rights reserved.
世界华人消化杂志. 2003-06-15; 11(6): 719-722
在线出版日期: 2003-06-15. doi: 10.11569/wcjd.v11.i6.719
西安酒精性肝病流行病学
鲁晓岚, 陶明, 罗金燕, 耿燕, 赵平, 赵红莉
鲁晓岚, 罗金燕, 赵平, 赵红莉, 西安交通大学第二医院消化病研究室 陕西省西安市 710004
陶明, 西安交通大学医学院流行病学教研室 陕西省西安市 710061
耿燕, 西安交通大学第二医院检验科 陕西省西安市 710004
基金项目: 卫生部科研基金资助课题, No. 98-1-236.
通讯作者: 鲁晓岚, 710004, 陕西省西安市西五路157号, 西安交通大学第二医院消化病研究室. Xiaolan_lu@163.com
电话: 029-7276936-29660 传真: 029-7231758
收稿日期: 2002-10-08
修回日期: 2002-10-15
接受日期: 2002-10-18
在线出版日期: 2003-06-15

目的

酒精性肝病近年呈增长之势, 世界各国对其越来越重视. 本研究采用流行病学方法调查西安地区人群的饮酒情况, 初步明确酒精性肝病的患病率及与饮酒的关系.

方法

将西安城乡9种代表性职业人群作为本次调查对象, 整群随机抽样, 采取问卷调查方法, 由专人统一询问检测.

结果

2000-04/06共调查9种职业人群3 613例, 其中饮酒人数1270例, 占35.2%, 90.1%为男性, 是男性群体的52.2%, 女性仅126例. 检出酒精性肝病患者82例, 占6.5%, 为调查人数的2.3%, 只1例女性. 酒精性肝硬化4例, 分别占0.3%和0.1%. 78例酒精性脂肪肝患者日均饮酒31.3±24.2 g, 平均饮酒14.0±7.4 a, 且随饮酒量和饮酒时限增加, ALT和AST亦渐升高. 发病高峰年龄在40岁左右. 营养不良可能加重肝功能损伤.

结论

西安地区饮酒现象较普遍, 男性为主要饮酒人群. 酒精性脂肪肝为酒精性肝病最常见类型, 患病率2.2%, 日均饮酒30 g, 持续14 a即可能患此病, 且与ALT、AST水平有正向关系.

关键词: N/A
引文著录: 鲁晓岚, 陶明, 罗金燕, 耿燕, 赵平, 赵红莉. 西安酒精性肝病流行病学. 世界华人消化杂志 2003; 11(6): 719-722
Epidemiology of alcoholic liver diseases in Xi'an
Xiao-Lan Lu, Ming Tao, Jin-Yan Luo, Yan Gen, Ping Zhao, Hong-Li Zhao
Xiao-Lan Lu, Jin-Yan Luo, Ping Zhao, Hong-Li Zhao, Department of Digestive Diseases, The Second Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
Ming Tao, Department of Epidemiology, Xi'an Jiaotong University Medical College, Xi'an 710061, Shaanxi Province, China
Yan Gen, Department of Laboratory Medicine, The Second Hospital, Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
Supported by: the Scientific Foundation of Ministry of Public Health, No. 98-1-236.
Correspondence to: Dr. Xiao-Lan Lu, Department of Digestive Diseases, The Second Hospital of Xi'an Jiaotong University, 157 Xiwulu , Xi'an 710004, Shaanxi Province, China. Xiaolan-lu@163.com
Received: October 8, 2002
Revised: October 15, 2002
Accepted: October 18, 2002
Published online: June 15, 2003

AIM

To investigate the characteristics of ethanol consumption in Xi'an area, and to explore the prevalence of alcoholic liver disease and the correlation of the quantity of ethanol consumed with the development of alcoholic liver disease.

METHODS

By random cluster sampling, 9 professional groups of people were chosen in the city and the rural areas as subjects. Questionaire was taken and the data collected and analyzed by specialists.

RESULTS

During April to June 2000, 3 613 persons were investigated. Among them 1270 were drinkers, in which 90.1% were males and only 126 females. 78 persons were alcoholic fatty liver patients (6.1%). The prevalence rate was 2.2% in all subjects. Only one female patient with alcoholic liver disease (0.3%), and 5 cases of alcoholic cirrhosis (0.1%) were found. Alcoholic fatty liver patients consumed the equivalent of 31.3+24.2 g absolute ethanol with a mean duration of 14.0+7.4 years. With increase of alcoholic consumption the serum levels of ALT and AST increased. The prevalence rate of alcoholic fatty liver is higher in city than that in rural area.

CONCLUSION

Alcohol drinkers in Xi'an are very popular. Males are the major population. Alcoholic fatty liver is the most common type of ALD with prevalence rate of 2.2%. The equivalent of 30 g ethanol consumed in more than 14 years may result in alcoholic fatty liver. The alterations of liver function are parallel to the consumption of alcohol.

Key Words: N/A
0 引言

随着酒精消耗量的增多, 饮酒引发的肝脏疾病越来越多[1,2]. 酒精性肝病(alcoholic liver disease, ALD), 包括酒精性脂肪肝(alcoholic fatty liver, AF)、酒精性肝炎(alcoholic hepatitis, AH)和酒精性肝硬化(alcoholic cirrhosis, AC)[3]. ALD的研究在我国刚刚起步, 缺乏人群统计资料. 为明确其在我市患病率, 及每日饮多少酒、持续饮酒多长时间有患ALD危险性, 及其他影响因素, 我们于2000-04/06对西安地区城乡不同职业人群进行了随机抽样调查.

1 材料和方法

西安城乡年满18岁各种职业人群作为本次调查对象, 整群随机抽样, 问卷调查, 调查表统一设计, 统一标准, 人员统一培训, 对每一调查对象负责询问、查体、腹部B超(型号: 西门子亚当)检查, 并行肝功、HBV标志物、抗-HCV、血糖、血脂等检测. 酒精性肝病诊断标准参考1995年全国第一次酒精性肝病会议标准: 酒精性脂肪肝: 有长期饮酒史, 即: 持续饮酒1 a以上, 每日饮酒折合酒精量＞20 g；B超或CT有典型脂肪肝特异性改变；轻型患者肝功可基本正常. 酒精性肝硬化: 长期饮酒史同上；B超或CT有肝硬化证据. 酒精量换算公式为: 饮酒量(ml)×酒精含量(％)×0.8(酒精比重) ＝ g. 并除外病毒感染、糖尿病、高脂血症及药物等引起的肝功损伤.

统计学处理 用SPSS 10.0统计软件包进行资料的录入及分析, 危险因素用logistic回归分析.

2 结果

2000-04/06我们共调查工人、农民、军人、机关干部、知识分子、商人、大学生、医务人员和饮食服务业人员共3700例, 剔除资料不完整者, 有效病例数3 613例. 男2191例, 占60.6%, 女1422例 , 占39.4%, 平均年龄36±13岁. 饮酒人数1270例, 占总数的35.1%. 男1144例, 占男性群体52.2%； 女126例, 为女性群体的8.9%, 主要分布在高收入家庭和家人有饮酒者中, 相当部分亦因工作需要而饮酒. 男女之比: 9.1:1. 不同职业人群饮酒暴露率工人、军人、商人最高, 在48.0%以上；其次是机关干部, 42.9%； 农民最低仅22.8%. 不同职业间差异非常明显, x2 = 164.4, P =0.000. AF在不同职业人群中的分布城市明显高于农村, 干部群体高于其他群体. 机关干部患病率最高18.7%； 其次是商人和知识分子, 分别为11.0%和9.0%. 患病率最低的是军人和大学生, 各只有1.4%和1.3%. 各组人群间AF患病率差异非常显著, x2 = 71.7, P = 0.000. 不同年龄组人群饮酒量及饮酒暴露率各异(表1), 20-50岁的青壮年为饮酒主要群体. 50-60岁以后饮酒人数明显下降. 各年龄组饮酒暴露率有显著性差异, x2 = 20.11, P = 0.003. 饮酒人群中, 783(61.7%)人平均每月最多饮酒1次, 197(15.5%)人每天至少饮酒1次, 常饮38°-60°白酒的556(43.7%)人, 其余则以葡萄酒, 啤酒等有色酒为主. 经常少量和偶尔大量饮酒者最多, 分别为619例和467例, 占总数的85.6%；经常大量及酗酒者只有58(4.6%)例. 可见人群中以间断少量饮酒, 饮低度酒、有色酒的人最多.

表1 不同年龄人群饮酒状况分析.
年龄(y)调查人数饮酒人数饮酒暴露率%
<202578432.7
20-1 23147638.7
30-88730033.8
40-64323736.9
50-33811032.5
60-1824524.7
≥70651827.7
x2 = 20.11, P = 0.003.

AF共检出78例(未检出合并乙肝或丙肝感染者), 占饮酒人数的6.1%, 为调查人数的2.2%, 女性仅1例. 73.6%集中在30-50岁年龄段, 平均年龄41±6岁. AC检出4例, 占饮酒人数的0.3%, 总人数的0.1%. AF患者平均每日饮酒量31.3±24.2 g, 平均饮酒时间14.0±7.4 a. 饮酒量最大者单次440 g, 日均220 g. 饮酒时间最短4 a, 最长47 a. 肝功正常者38例, 占48.7%. ALT和AST异常者均是轻、中度升高, AST无一超过3 334 nkat/L, 97.5%的患者ALT在3 334 nkat/L以内. ALT平均1 058±233 nkat/L, AST平均878±172 nkat/L. 仅γ-GT异常者4例, ALP异常者2例. 由表2肝功损害与饮酒的关系见, ALT和AST水平与日均饮酒量及饮酒年限间均有很好相关性, r分别为0.53和0.61, P<0.01. 随饮酒量和时间增长, AF患病率呈递增趋势(表3, 4), 饮酒量30 g一组和20 g两组间差异很明显, x2 = 6.29, P<0.05. 30 g以上各组间差异不显著, P>0.05. 饮酒15-20 a组和<5 a组AF患病率差异有统计学意义, x2 = 6.81, P<0.05. 日均饮酒量<40 g者占64.2%. 饮酒时间10 a以下者占33.3%.

表2 肝功损伤与饮酒量和年限的关系.
转氨酶(nkat/L)人数日均饮酒量(g)日最高饮酒量(g)饮酒年限(a)始饮酒年龄(y)
正 常3815.7±13.867.3±41.810.6±8.318.4±6.9
ALT<12542724.2±16.186.1±77.212.9±10.9018.0±9.3
ALT<33341140.7±32.2118.5±101.414.5±5.420.7±4.8
ALT≥3334275.0±49.540.3±31.525.0±14.123.0±4.24
AST<12542032.3±24.986.0±75.115.7±12.419.0±7.4
AST<3334275.0±49.440.3±31.525.0±14.123.0±4.24
表3 日均饮酒量与AF患病率关系.
日均饮酒量(g)饮酒人数AF患者数AF患病率(%)
<20880313.52
20-170148.24
30-42511.90
40-991313.13
≥50791518.99
x2 = 45.19, P = 0.000.
表4 饮酒年限与AF患病率的关系.
饮酒年限(a)饮酒人数AF患者数AF患病率(%)
<526272.68
5-293206.82
10-233135.58
15-143128.45
≥20339267.67
x2 = 11.30, P<0.025.

另外, 性别、经济收入、文化程度、家人饮酒情况、吸烟、水果蔬菜蛋奶肉等营养因素及年龄、职业、家族肝病史、肥胖等10个因素中, 前五个指标是饮酒的相关因素. 相对P值分别为0.18, 1.20, 1.20, 3.56和5.00, 回归系数分别为－1.70, 0.16, 0.17, 1.27和1.61. 营养可能为保护性因素, P值和回归系数分别为0.93和－0.07.

3 讨论

嗜酒可引发一系列肝脏疾患, 对社会劳动力影响较大[1,2], 重症患者死亡率较高[4,5], 且随酒精消耗量增加而增加[6]. 西方国家肝硬化几乎一半与酒精有关, 日本ALD患者也呈上升趋势[4]. 我国肝脏疾患虽仍以病毒性肝炎及肝炎肝硬化为主, 但随着生活水平提高, 嗜酒者在人群中的比例成倍增长. 近几年住院患者中ALD比前些年明显增加. 本资料显示, 饮酒者占一般人群的35.1%, 远高于1991年北京地区的调查；在男性人群中占52.2%, 与郝伟et al报道的湖南两地市的57.5%相近. 这可能与各地饮食, 文化及近几年经济发展差异和教育, 干预因素有关[7,8]. 经济因素对女性及农村人群的影响特别明显[9], 经济相对落后的农民饮酒率最低. 经济状况较好的机关干部、商人、军人等最高. 大多数资料显示, 饮酒除与职业相关外[10], 与性别亦相关, 男性均占主导地位[11,12], 与本资料相同. 但女性更敏感[13,14], 少量的酒, 更短时间就可致病.

酒精摄入体内放出较多热量, 抑制摄入者的食欲, 使蛋、奶等营养物质摄入减少, 脂质和蛋白质代谢紊乱, 有更大患肝病危险[15]. 故营养对饮酒者可能有一定保护作用[7,16], 营养不良则会加重肝功能损伤[17,18]. 但肥胖却会增加嗜酒者患肝病的危险[19].

酒精所致肝病, 除轻微病理改变者外, 最常见的为脂肪肝, 其次为肝硬化. 因脂肪肝可不经肝炎直接发展为肝硬化, 故AH相对少见. 我们未发现转氨酶明显升高, 或有发热、黄疸等典型症状的AH患者, 以脂肪肝的检出为主, 肝硬化检出率很低. 说明AF在我国人群, 特别是城市人群中已较普遍, 患病率已达2.2%, 在饮酒人群中达6.1%. 据统计, 酒精所致脂肪肝约占脂肪肝病因的近一半[20].

饮酒量和饮酒年限与AF患病率及肝功损伤有明显量效关系. 国外大多数资料提示: 平均每日饮酒40-120 g[21-23,12], 持续5-10 a可致ALD, AC则需更长时间[22]. 国内倾向40-50 g, 持续5 a以上. 英国和意大利则以日均30 g作为患ALD危险剂量[19], 并有时间依赖性升高. 这与我们资料每日饮酒30 g持续14 a左右可致肝病相符合. 同时比较了日均饮酒≤30 g且饮酒时间＜15 a, 和日均饮酒＞30 g且饮酒时间＞15 a的两组饮酒人群, AF患病率分别为2.0%和14.7%, x2 = 44.57, P = 0.000. 从表3, 4也可看出, 日均饮酒30 g和持续饮酒15 a以上组AF患病率明显高于低剂量和短年限各组. 说明长期大量饮酒是AF危险因素, 且在一定条件下各自可独立影响AF患病率. 本资料所有AF患者开始饮酒年龄一般在20岁左右, 患病高峰年龄在40岁左右, 与非酒精性脂肪肝发病高峰年龄类似[24]. 也说明持续饮酒10 a后是AF高发期. 这些均支持我们的结论. 可解释为何大学生和军人群体AF检出率较低. 干部群体AF比例高估计除与饮酒量有关外还和频度有关. 但饮酒是否患肝病个体差异较大[25,23], 与肿瘤等其他疾病一样可能与个人体质因素[26-29]、饮酒方式种类和生活习惯[30-32]有关, 如饮酒是否佐餐、饮茶[33]等.

AF患者中, 平均饮酒量和饮酒年限与肝损伤明显正相关[19], 随饮酒量和饮酒持续时间增加, ALT与AST水平随之升高. 我们提倡少饮酒, 勿持续饮酒. 但当ALT与AST达3 334.0 nkat/L时, 最高饮酒量有所减少. 推测与患者出现自觉症状后开始自我控制. 有报道AF患者肝功AST/ALT>2[34], γ-GT升高较明显, 本组资料及国外部分资料未发现此特点[11]. 可能系体检人群, 患者几无症状, 肝功损伤轻, 以细胞质中ALT的释出为主. 出现黄疸者很少见. 国外报道ALD与乙型和丙型肝炎合并存在者较多[35,36], 特别是对HCV的易感性增加[37,38]. 我们未发现此关系, 与Miyano et al[39]的报道相似. 可能与国外HCV感染率高[40], 国内吸毒、药瘾人数较少、HCV感染率相对较低有关[41,42].

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