肝纤维化筛查可提高戒酒率

IF 9.5 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

JHEP Reports Pub Date : 2024-07-02 DOI:10.1016/j.jhepr.2024.101165

Emma Avitabile , Jordi Gratacós-Ginès , Martina Pérez-Guasch , Ana Belén Rubio , Queralt Herms , Marta Cervera , Ruth Nadal , Marta Carol , Núria Fabrellas , Pol Bruguera , Ana Llorente , Lluisa Ortega , Anna Lligoña , Laura Nuño , Neus Freixa , María Teresa Pons , Alba Díaz , Ramon Bataller , Pere Ginès , Hugo López-Pelayo , Elisa Pose

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引用次数: 0

摘要

背景& 目的酒精使用障碍（AUD）患者有罹患肝病的风险。有关肝纤维化筛查对饮酒量影响的信息很少。因此，我们评估了肝纤维化筛查项目对 AUD 患者饮酒量的影响。筛查队列包括成瘾科的 AUD 患者，他们在肝病科接受了瞬态弹性成像肝纤维化筛查和生活习惯咨询。对照组包括具有相似特征的患者，他们在前一阶段曾在同一科室就诊，但未接受筛查。结果在筛查队列中，149/334（45%）人在 6 个月后戒酒（68% 经尿液葡萄糖醛酸乙酯证实）。筛查人群中的戒酒率高于对照人群（40/137 [29%]，P = 0.002）。在对两个合并队列（n = 471）进行的多变量分析中，与戒酒相关的因素有：接受 AUD 药物治疗（几率比 [OR] 1.72，95% CI 1.11-2.67）、未使用非法药物（OR 0.50，95% CI 0.31-0.80）和参与筛查计划（OR 1.77，95% CI 1.14-2.74）。在筛查队列中，40 人（12%）的肝脏硬度增加（≥8 kPa），这与肥胖（p = 0.03）、动脉高血压（p = 0.03）、γ-谷氨酰转移酶（p <0.001）和血小板水平（p = 0.001）有关。影响和意义：与普通人群相比，高酒精消耗量人群罹患肝病的风险更高。对这一人群进行肝病筛查的潜在益处还鲜有研究。我们的研究表明，与未接受筛查的匹配人群相比，肝纤维化筛查项目和生活方式咨询干预措施有助于酗酒者在6个月后戒酒。这些研究结果表明，肝纤维化筛查项目对酒精使用障碍患者有治疗作用，支持在戒酒机构实施这些项目。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Liver fibrosis screening increases alcohol abstinence

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Liver fibrosis screening increases alcohol abstinence

Background & Aims

Individuals with alcohol use disorder (AUD) are at risk of liver disease. There is scarce information on the effectiveness of screening for liver fibrosis on alcohol consumption. Thus, we evaluated the efficacy of a screening program for liver fibrosis on alcohol consumption in individuals with AUD.

Methods

We performed a prospective interventional study in the Hospital Clinic of Barcelona. The screening cohort included individuals with AUD from the addiction unit who underwent screening for liver fibrosis with transient elastography and counselling on lifestyle habits in the liver unit. The control cohort included individuals with similar characteristics who attended the same unit in a previous period but did not undergo screening. Effects on alcohol consumption were evaluated at 6 months, after clinical follow-up, with clinical assessment by addiction specialists and urine ethyl glucuronide monitoring.

Results

In the screening cohort, 149/334 (45%) individuals were abstinent at 6 months (68% confirmed with urine ethyl glucuronide). Alcohol abstinence was higher in the screening cohort than in the control cohort (40/137 [29%], p = 0.002). Factors associated with alcohol abstinence in the multivariate analysis of the two combined cohorts (n = 471) were: receiving AUD medications (odds ratio [OR] 1.72, 95% CI 1.11-2.67), absence of illicit drug use (OR 0.50, 95% CI 0.31-0.80) and participating in the screening program (OR 1.77, 95% CI 1.14-2.74). In the screening cohort, 40 (12%) individuals had increased liver stiffness (≥8 kPa), which was associated with obesity (p = 0.03), arterial hypertension (p = 0.03), gamma-glutamyltransferase (p <0.001) and platelet levels (p = 0.001).

Conclusions

This study shows that an integrated screening program for liver fibrosis associated with counselling on alcohol consumption in individuals with AUD allows for early diagnosis of alcohol-associated liver disease and is associated with alcohol abstinence.

Impact and implications:

Individuals with high alcohol consumption are at higher risk of liver disease compared to the general population. The potential beneficial effects of screening for liver disease in this population have scarcely been studied. We show that a screening program for liver fibrosis together with a lifestyle counselling intervention favoured alcohol abstinence among individuals with alcohol use disorder attending an addiction unit at 6 months, compared to a matched cohort who did not undergo screening. These findings suggest that screening programs for liver fibrosis have a therapeutic role in individuals with alcohol use disorder, supporting the implementation of these programs in addiction units.

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来源期刊

JHEP Reports GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

12.40

自引率

2.40%

发文量

161

审稿时长

36 days

期刊介绍： JHEP Reports is an open access journal that is affiliated with the European Association for the Study of the Liver (EASL). It serves as a companion journal to the highly respected Journal of Hepatology. The primary objective of JHEP Reports is to publish original papers and reviews that contribute to the advancement of knowledge in the field of liver diseases. The journal covers a wide range of topics, including basic, translational, and clinical research. It also focuses on global issues in hepatology, with particular emphasis on areas such as clinical trials, novel diagnostics, precision medicine and therapeutics, cancer research, cellular and molecular studies, artificial intelligence, microbiome research, epidemiology, and cutting-edge technologies. In summary, JHEP Reports is dedicated to promoting scientific discoveries and innovations in liver diseases through the publication of high-quality research papers and reviews covering various aspects of hepatology.