{"title":"在肝病门诊部对患有酒精使用障碍的慢性肝病患者进行简短干预:效果和局限性。","authors":"Nagisa Hara, Atsushi Hiraoka, Masato Nakai, Makoto Shiraki, Tadashi Namisaki, Hisamitsu Miyaaki, Takuro Hisanaga, Hirokazu Takahashi, Hideko Ohama, Fujimasa Tada, Naoya Sakamoto, Kazuhiko Nakao, Taro Takami, Yuichiro Eguchi, Hitoshi Yoshiji","doi":"10.1111/hepr.14060","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aim</h3>\n \n <p>It is not uncommon to encounter outpatients in the hepatology department with harmful alcohol habits. When treating such chronic liver disease (CLD) patients, an adequate intervention method for harm reduction of alcohol use, such as brief intervention (BI) or BI and nalmefene, should be considered. This study aimed to elucidate the clinical effectiveness of BI for CLD patients affected by harmful alcohol use.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>From June 2021 to 2023, 123 Japanese CLD outpatients (hepatitis B virus : hepatitis C virus : alcoholic liver disease : others = 32:18:42:31) with an Alcohol Use Disorders Identification Test (AUDIT) score of ≥8 at the initial interview and a repeat interview with AUDIT 9 months later were enrolled. Clinical features related to patient behavior following the initial AUDIT interview were retrospectively evaluated, and compared between patients without and with BI treatment.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>For the non-BI and BI groups, baseline AUDIT score (median 10 [interquartile range (IQR) 9–13] vs. 12 [IQR 10–17], <i>p</i> = 0.016) and relative change in AUDIT score (median 0 [IQR −3 to 2] vs. −3 [IQR −7 to 0], <i>p</i> < 0.01) showed significant differences, whereas there was no significant difference between the groups for AUDIT score at the time of the second interview (<i>p</i> = 0.156). Following BI, significant improvements were observed for items 1, 2, 3, 4, 5, 8, and 10 of AUDIT (each <i>p</i> < 0.05).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Patients with an alcohol use disorder as well as those with alcohol dependency who received BI showed a significant decline in AUDIT score, although the score of the follow-up AUDIT indicated continued alcohol use disorder. In addition to BI, medication with nalmefene should be considered, based on individual factors.</p>\n </section>\n </div>","PeriodicalId":12987,"journal":{"name":"Hepatology Research","volume":"54 11","pages":"1099-1105"},"PeriodicalIF":3.9000,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Brief intervention for chronic liver disease patients with alcohol use disorder in a hepatology outpatient unit: Effects and limitations\",\"authors\":\"Nagisa Hara, Atsushi Hiraoka, Masato Nakai, Makoto Shiraki, Tadashi Namisaki, Hisamitsu Miyaaki, Takuro Hisanaga, Hirokazu Takahashi, Hideko Ohama, Fujimasa Tada, Naoya Sakamoto, Kazuhiko Nakao, Taro Takami, Yuichiro Eguchi, Hitoshi Yoshiji\",\"doi\":\"10.1111/hepr.14060\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Aim</h3>\\n \\n <p>It is not uncommon to encounter outpatients in the hepatology department with harmful alcohol habits. When treating such chronic liver disease (CLD) patients, an adequate intervention method for harm reduction of alcohol use, such as brief intervention (BI) or BI and nalmefene, should be considered. This study aimed to elucidate the clinical effectiveness of BI for CLD patients affected by harmful alcohol use.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>From June 2021 to 2023, 123 Japanese CLD outpatients (hepatitis B virus : hepatitis C virus : alcoholic liver disease : others = 32:18:42:31) with an Alcohol Use Disorders Identification Test (AUDIT) score of ≥8 at the initial interview and a repeat interview with AUDIT 9 months later were enrolled. Clinical features related to patient behavior following the initial AUDIT interview were retrospectively evaluated, and compared between patients without and with BI treatment.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>For the non-BI and BI groups, baseline AUDIT score (median 10 [interquartile range (IQR) 9–13] vs. 12 [IQR 10–17], <i>p</i> = 0.016) and relative change in AUDIT score (median 0 [IQR −3 to 2] vs. −3 [IQR −7 to 0], <i>p</i> < 0.01) showed significant differences, whereas there was no significant difference between the groups for AUDIT score at the time of the second interview (<i>p</i> = 0.156). Following BI, significant improvements were observed for items 1, 2, 3, 4, 5, 8, and 10 of AUDIT (each <i>p</i> < 0.05).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Patients with an alcohol use disorder as well as those with alcohol dependency who received BI showed a significant decline in AUDIT score, although the score of the follow-up AUDIT indicated continued alcohol use disorder. In addition to BI, medication with nalmefene should be considered, based on individual factors.</p>\\n </section>\\n </div>\",\"PeriodicalId\":12987,\"journal\":{\"name\":\"Hepatology Research\",\"volume\":\"54 11\",\"pages\":\"1099-1105\"},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2024-05-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Hepatology Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/hepr.14060\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hepatology Research","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/hepr.14060","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的:在肝病科门诊中,经常会遇到有酗酒习惯的患者。在治疗这类慢性肝病(CLD)患者时,应考虑采用适当的干预方法来减少饮酒危害,如简短干预(BI)或 BI 和纳美芬。本研究旨在阐明简短干预对受有害饮酒影响的慢性肝病患者的临床疗效:方法:从 2021 年 6 月至 2023 年 6 月,共招募了 123 名日本 CLD 门诊患者(乙型肝炎病毒:丙型肝炎病毒:酒精性肝病:其他 = 32:18:42:31),这些患者在初次访谈时酒精使用障碍鉴定测试(AUDIT)得分≥8 分,并在 9 个月后再次接受 AUDIT 访谈。对初次 AUDIT 问诊后患者行为的相关临床特征进行了回顾性评估,并对未接受 BI 治疗和接受 BI 治疗的患者进行了比较:非 BI 组和 BI 组的基线 AUDIT 评分(中位数 10 [四分位距(IQR)9-13] vs. 12 [四分位距(IQR)10-17],P = 0.016)和 AUDIT 评分的相对变化(中位数 0 [四分位距(IQR)-3-2] vs. -3 [四分位距(IQR)-7-0],P = 0.016接受 BI 治疗的酒精使用障碍患者和酒精依赖患者的 AUDIT 评分显著下降,但随访 AUDIT 评分显示酒精使用障碍仍在继续。除 BI 外,还应根据个人因素考虑使用纳美芬药物治疗。
Brief intervention for chronic liver disease patients with alcohol use disorder in a hepatology outpatient unit: Effects and limitations
Aim
It is not uncommon to encounter outpatients in the hepatology department with harmful alcohol habits. When treating such chronic liver disease (CLD) patients, an adequate intervention method for harm reduction of alcohol use, such as brief intervention (BI) or BI and nalmefene, should be considered. This study aimed to elucidate the clinical effectiveness of BI for CLD patients affected by harmful alcohol use.
Methods
From June 2021 to 2023, 123 Japanese CLD outpatients (hepatitis B virus : hepatitis C virus : alcoholic liver disease : others = 32:18:42:31) with an Alcohol Use Disorders Identification Test (AUDIT) score of ≥8 at the initial interview and a repeat interview with AUDIT 9 months later were enrolled. Clinical features related to patient behavior following the initial AUDIT interview were retrospectively evaluated, and compared between patients without and with BI treatment.
Results
For the non-BI and BI groups, baseline AUDIT score (median 10 [interquartile range (IQR) 9–13] vs. 12 [IQR 10–17], p = 0.016) and relative change in AUDIT score (median 0 [IQR −3 to 2] vs. −3 [IQR −7 to 0], p < 0.01) showed significant differences, whereas there was no significant difference between the groups for AUDIT score at the time of the second interview (p = 0.156). Following BI, significant improvements were observed for items 1, 2, 3, 4, 5, 8, and 10 of AUDIT (each p < 0.05).
Conclusion
Patients with an alcohol use disorder as well as those with alcohol dependency who received BI showed a significant decline in AUDIT score, although the score of the follow-up AUDIT indicated continued alcohol use disorder. In addition to BI, medication with nalmefene should be considered, based on individual factors.
期刊介绍:
Hepatology Research (formerly International Hepatology Communications) is the official journal of the Japan Society of Hepatology, and publishes original articles, reviews and short comunications dealing with hepatology. Reviews or mini-reviews are especially welcomed from those areas within hepatology undergoing rapid changes. Short communications should contain concise definitive information.