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酒精性肝病患者肝移植后生存及再饮酒研究
 发布时间:2022/7/16 浏览次数:404

酒精性肝病患者肝移植后生存及再饮酒研究
作者:段方方1  张欣雪2  刘晨1  常春艳1  成军1  李先亮2  杨松1 3 
单位:1.首都医科大学附属北京地坛医院 肝病中心 北京100015 2.首都医科大学附属北京朝阳医院 肝胆胰脾外科 北京100020 3.北京大学地坛医院教学医院肝病中心 北京 100015 
关键词:酒精性肝病 酒精性肝炎 肝移植 戒酒 
分类号:
出版年,卷(期):页码:2021,13(3):62-67
摘要:
摘要:目的 初步明确我国酒精性肝病(alcoholic liver disease,ALD)肝移植患者术 后生存及再饮酒情况,明确术前不同戒酒时间及不同类型ALD患者生存及再饮酒的 差异。方法 入组2016年10月至2019年10月于首都医科大学附属北京朝阳医院因ALD (包括重症酒精性肝炎、酒精性肝硬化及酒精性肝癌)首次行肝移植的36例患者。收 集患者人口学指标(年龄、性别等)、移植前饮酒时间及戒酒时间、合并肝硬化并发 症(食管胃底静脉曲张出血等)、合并精神疾病及是否退休等,随访患者移植后生 存及再饮酒情况。根据入组患者移植前戒酒时间将其分为移植前戒酒时间≥ 6个月组 (13例)与移植前戒酒时间 < 6个月组(23例);根据入组患者酒精性肝病类型将其 分重症酒精性肝炎组(9例)与酒精性肝硬化/肝癌组(27例)。采用Fisher检验比较各 组患者的再饮酒率。采用Log-rank法比较各组患者生存情况差异。结果 本研究共入组 ALD相关肝移植患者36例,术后随访时间为3~41.5个月,共3例(8.3%)患者病死。 随访6个月、1年及2年累积生存率分别为97.2%、91.7%与91.7%。重症酒精性肝炎组 患者与酒精性肝硬化/肝癌组患者生存曲线差异无统计学意义(Log-rank χ2 = 1.039, P = 0.308)。移植前戒酒≥ 6个月组与戒酒< 6个月组患者累积生存情况差异无统计 学意义(Log-rank χ2 = 0.019,P = 0.891)。36例患者累积随访至1年再饮酒率为2.8% (1/36),移植前戒酒≥ 6个月患者与戒酒< 6个月患者随访至1年的再饮酒率差异无统 计学意义(0% vs 4.35%,P = 1.000)。重症酒精性肝炎组患者与酒精性肝硬化/肝癌组 患者再饮酒率差异无统计学意义(11.1% vs 0%,P = 1.000)。结论 初步证据提示ALD 相关肝移植患者术后生存情况良好,暂无证据提示重症酒精性肝炎与酒精性肝硬化/肝 癌患者移植前戒酒时间≥ 6个月与移植前戒酒时间< 6个月患者的生存及再饮酒有差 异,需扩大队列并延长随访时间进一步验证。
Abstract: Objective To investigate the survival profile and alcohol drinking status in patients who underwent liver transplantation for alcoholic liver disease (ALD) and to clarify the differences of survival and redrinking in patients with different preoperative alcohol withdrawal time and different subtypes of ALD. Methods Patients who underwent liver transplantation for ALD (including severe alcoholic hepatitis, alcoholic cirrhosis, and primary liver cancer) in Beijing Chaoyang Hospital, Capital Medical University from October 2016 to October 2019 were enrolled (36 cases). The demographic indexes (age, gender, etc.), drinking time and abstinence time before transplantation, complications of liver cirrhosis (esophageal and gastric variceal bleeding, etc.), mental illness and retirement were collected. The survival and drinking status of patients were followed up. According to the abstinence time before transplantation, the patients were divided into abstinence time ≥ 6 months before transplantation group (13 cases) and abstinence time < 6 months before transplantation group (23 cases). According to the type of ALD, the patients were divided into severe alcoholic hepatitis group (9 cases) and alcoholic cirrhosis/primary liver cancer group (27 cases). The relapse rate of patients in different groups were compared by Fisher test. The differences of survival curve were compared by Log-rank method. Results A total of 36 patients who underwent liver transplantation for ALD were enrolled. The follow-up time was 3~41.5 months, 3 (8.3%) patients died during follow-up. The cumulative survival rate at 6 months, 1 year and 2 years were 97.2%, 91.7% and 91.7%, respectively. There was no statistically significant difference in cumulative survival between patients with severe alcoholic hepatitis and alcoholic cirrhosis/primary liver cancer (Log-rank χ2 = 1.039, P = 0.308). There was no statistically significant difference in cumulative survival rate between patients with abstinence time before transplantation ≥ 6 months and abstinence time < 6 months before transplantation (Log-rank χ2 = 0.019, P = 0.891). There was 1 case (2.8%) who got alcohol relapse after 1-year follow-up. There was no statistically significant difference in relapse rate between patients with abstinence time ≥ 6 months before transplantation and abstinence time < 6 months before transplantation (0% vs 4.35%,P = 1.000). Also, there was no statistically significant difference in relapse rate between patients in severe alcoholic hepatitis group and alcoholic cirrhosis/primary liver cancer group (11.1% vs 0%, P = 1.000). Conclusions Preliminary data showed good prognosis in patients who underwent liver transplantation for ALD. Current data showed no difference between patients with severe alcoholic hepatitis and alcoholic cirrhosis/primary liver cancer patients with abstinence time ≥ 6 months before transplantation and abstinence time < 6 months before transplantation in alcohol relapse or survival. Further studies with larger samples and longer follow-up are required to verify the results.
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