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酒精性心肌病

Authors
Ihsan M Rafie, MRCP
Wilson S Colucci, MD
Section Editor
William J McKenna, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC
Translators
王方芳, 主治医师

引言

长期过量饮酒是继发性扩张型心肌病的主要原因[1,2](表 1)。然而，如果早期诊断疾病并减少或停止进一步的酒精摄入，则心脏功能可恢复。 (参见“扩张型心肌病的病因”)

本专题将讨论酒精性心肌病的发病机制、诊断及治疗。饮酒的综合风险与获益及心血管风险与获益将单独讨论。 (参见“饮酒的风险与益处概述”和“适量饮酒对心血管的益处及风险”)

定义

酒精性心肌病是一种获得性扩张型心肌病，该病与长期大量饮酒相关，通常定义为乙醇摄入量大于80g/d持续至少5年(表 1)。与其他扩张型心肌病类型相似，酒精性心肌病的特征为左心室(left ventricle, LV)扩张、LV质量增加、LV收缩功能障碍[一般根据左室射血分数(left ventricular ejection fraction, LVEF)检测出]。 (参见下文‘诊断’)

患病率

根据研究人群的特征和用于确定酒精性心肌病的饮酒阈值，针对心力衰竭或扩张型心肌病患者的病例系列研究所报道的酒精性心肌病患病率有很大差异(如，从4%至40%或以上)[3]。

饮酒男性和女性的酒精性心肌病患病率似乎相近，然而在女性中，发生该病的乙醇总剂量更低[4,5]。在一项纳入50例无症状酗酒女性和100例无症状酗酒男性的病例系列研究中，两组均有约1/3的患者存在LV功能不全的表现[4]。LV收缩功能障碍与乙醇终身总剂量相关[4]。然而，当对患者的LVEF进行匹配后，与男性相比，女性摄入的校正体重后的乙醇总量较少。因此，女性似乎对心脏毒性更敏感；在酒精性肝病和酒精性肌病中，也发现了相似的易感性。该性别差异一个机制为，在女性中，乙醇在胃内的代谢更低且在肝脏中的代谢更高，这使得在女性体内乙醇代谢产物存在过度蓄积[6]。 (参见“酒精性肝病的发病机制”，关于‘胃中乙醇代谢’一节)

                         

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Literature review current through: 2017-06 . | This topic last updated: 2016-12-22.
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References
Top
  1. McKenna CJ, Codd MB, McCann HA, Sugrue DD. Alcohol consumption and idiopathic dilated cardiomyopathy: a case control study. Am Heart J 1998; 135:833.
  2. Piano MR, Schwertz DW. Alcoholic heart disease: a review. Heart Lung 1994; 23:3.
  3. Guzzo-Merello G, Cobo-Marcos M, Gallego-Delgado M, Garcia-Pavia P. Alcoholic cardiomyopathy. World J Cardiol 2014; 6:771.
  4. Urbano-Márquez A, Estruch R, Fernández-Solá J, et al. The greater risk of alcoholic cardiomyopathy and myopathy in women compared with men. JAMA 1995; 274:149.
  5. Fernández-Solà J, Estruch R, Nicolás JM, et al. Comparison of alcoholic cardiomyopathy in women versus men. Am J Cardiol 1997; 80:481.
  6. Baraona E, Abittan CS, Dohmen K, et al. Gender differences in pharmacokinetics of alcohol. Alcohol Clin Exp Res 2001; 25:502.
  7. Estruch R, Fernández-Solá J, Sacanella E, et al. Relationship between cardiomyopathy and liver disease in chronic alcoholism. Hepatology 1995; 22:532.
  8. Kloner RA, Rezkalla SH. To drink or not to drink? That is the question. Circulation 2007; 116:1306.
  9. O'Keefe JH, Bhatti SK, Bajwa A, et al. Alcohol and cardiovascular health: the dose makes the poison…or the remedy. Mayo Clin Proc 2014; 89:382.
  10. Di Castelnuovo A, Costanzo S, Bagnardi V, et al. Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med 2006; 166:2437.
  11. http://www.icap.org/Table/InternationalDrinkingGuidelines (Accessed on February 10, 2015).
  12. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at: http://health.gov/dietaryguidelines/2015/guidelines/ (Accessed on January 09, 2016).
  13. Walsh CR, Larson MG, Evans JC, et al. Alcohol consumption and risk for congestive heart failure in the Framingham Heart Study. Ann Intern Med 2002; 136:181.
  14. Bryson CL, Mukamal KJ, Mittleman MA, et al. The association of alcohol consumption and incident heart failure: the Cardiovascular Health Study. J Am Coll Cardiol 2006; 48:305.
  15. Klatsky AL, Chartier D, Udaltsova N, et al. Alcohol drinking and risk of hospitalization for heart failure with and without associated coronary artery disease. Am J Cardiol 2005; 96:346.
  16. Djoussé L, Gaziano JM. Alcohol consumption and heart failure: a systematic review. Curr Atheroscler Rep 2008; 10:117.
  17. Padilla H, Michael Gaziano J, Djoussé L. Alcohol consumption and risk of heart failure: a meta-analysis. Phys Sportsmed 2010; 38:84.
  18. Gonçalves A, Claggett B, Jhund PS, et al. Alcohol consumption and risk of heart failure: the Atherosclerosis Risk in Communities Study. Eur Heart J 2015; 36:939.
  19. Wilke A, Kaiser A, Ferency I, Maisch B. [Alcohol and myocarditis]. Herz 1996; 21:248.
  20. Lee WK, Regan TJ. Alcoholic cardiomyopathy: is it dose-dependent? Congest Heart Fail 2002; 8:303.
  21. Lazarević AM, Nakatani S, Nesković AN, et al. Early changes in left ventricular function in chronic asymptomatic alcoholics: relation to the duration of heavy drinking. J Am Coll Cardiol 2000; 35:1599.
  22. Kajander OA, Kupari M, Laippala P, et al. Dose dependent but non-linear effects of alcohol on the left and right ventricle. Heart 2001; 86:417.
  23. Kelbaek H, Gjørup T, Brynjolf I, et al. Acute effects of alcohol on left ventricular function in healthy subjects at rest and during upright exercise. Am J Cardiol 1985; 55:164.
  24. Waszkiewicz N, Szulc A, Zwierz K. Binge drinking-induced subtle myocardial injury. Alcohol Clin Exp Res 2013; 37:1261.
  25. Fauchier L, Babuty D, Poret P, et al. Comparison of long-term outcome of alcoholic and idiopathic dilated cardiomyopathy. Eur Heart J 2000; 21:306.
  26. Kupari M, Koskinen P, Suokas A, Ventilä M. Left ventricular filling impairment in asymptomatic chronic alcoholics. Am J Cardiol 1990; 66:1473.
  27. Patel VB, Why HJ, Richardson PJ, Preedy VR. The effects of alcohol on the heart. Adverse Drug React Toxicol Rev 1997; 16:15.
  28. Lange LG, Sobel BE. Myocardial metabolites of ethanol. Circ Res 1983; 52:479.
  29. Preedy VR, Atkinson LM, Richardson PJ, Peters TJ. Mechanisms of ethanol-induced cardiac damage. Br Heart J 1993; 69:197.
  30. Zhang X, Li SY, Brown RA, Ren J. Ethanol and acetaldehyde in alcoholic cardiomyopathy: from bad to ugly en route to oxidative stress. Alcohol 2004; 32:175.
  31. Oba T, Maeno Y, Ishida K. Differential contribution of clinical amounts of acetaldehyde to skeletal and cardiac muscle dysfunction in alcoholic myopathy. Curr Pharm Des 2005; 11:791.
  32. Ren J, Wold LE. Mechanisms of alcoholic heart disease. Ther Adv Cardiovasc Dis 2008; 2:497.
  33. Laurent D, Mathew JE, Mitry M, et al. Chronic ethanol consumption increases myocardial mitochondrial DNA mutations: a potential contribution by mitochondrial topoisomerases. Alcohol Alcohol 2014; 49:381.
  34. Figueredo VM, Chang KC, Baker AJ, Camacho SA. Chronic alcohol-induced changes in cardiac contractility are not due to changes in the cytosolic Ca2+ transient. Am J Physiol 1998; 275:H122.
  35. Thomas AP, Rozanski DJ, Renard DC, Rubin E. Effects of ethanol on the contractile function of the heart: a review. Alcohol Clin Exp Res 1994; 18:121.
  36. Piano MR, Phillips SA. Alcoholic cardiomyopathy: pathophysiologic insights. Cardiovasc Toxicol 2014; 14:291.
  37. Fernández-Solà J, Fatjó F, Sacanella E, et al. Evidence of apoptosis in alcoholic cardiomyopathy. Hum Pathol 2006; 37:1100.
  38. Cheng CP, Cheng HJ, Cunningham C, et al. Angiotensin II type 1 receptor blockade prevents alcoholic cardiomyopathy. Circulation 2006; 114:226.
  39. Klatsky AL, Friedman GD, Siegelaub AB, Gérard MJ. Alcohol consumption and blood pressure. Kaiser-Permanente Multiphasic Health Examination data. N Engl J Med 1977; 296:1194.
  40. Kaplan NM. Alcohol and hypertension. Lancet 1995; 345:1588.
  41. Fernández-Solà J, Nicolás JM, Oriola J, et al. Angiotensin-converting enzyme gene polymorphism is associated with vulnerability to alcoholic cardiomyopathy. Ann Intern Med 2002; 137:321.
  42. Gubbay ER. Beri-Beri heart disease. Can Med Assoc J 1966; 95:21.
  43. Teragaki M, Takeuchi K, Takeda T. Clinical and histologic features of alcohol drinkers with congestive heart failure. Am Heart J 1993; 125:808.
  44. Chun JL, O'Brien R, Berry SE. Cardiac dysfunction and pathology in the dystrophin and utrophin-deficient mouse during development of dilated cardiomyopathy. Neuromuscul Disord 2012; 22:368.
  45. Tandler B, Dunlap M, Hoppel CL, Hassan M. Giant mitochondria in a cardiomyopathic heart. Ultrastruct Pathol 2002; 26:177.
  46. Fernandez-Sola J, Estruch R, Grau JM, et al. The relation of alcoholic myopathy to cardiomyopathy. Ann Intern Med 1994; 120:529.
  47. Sudarikova YuV, Bakeeva LE, Tsiplenkova VG. Ultrastructure of mitochondrial reticulum of human cardiomyocytes in alcohol cardiomyopathy. Biochemistry (Mosc) 1997; 62:989.
  48. Mashimo K, Sato S, Ohno Y. Chronic effects of ethanol on cultured myocardial cells: ultrastructural and morphometric studies. Virchows Arch 2003; 442:356.
  49. Mikami K, Sato S, Watanabe T. Acute effects of ethanol on cultured myocardial cells: an ultrastructural study. Alcohol Alcohol 1990; 25:651.
  50. Hu C, Ge F, Hyodo E, et al. Chronic ethanol consumption increases cardiomyocyte fatty acid uptake and decreases ventricular contractile function in C57BL/6J mice. J Mol Cell Cardiol 2013; 59:30.
  51. Cherpachenko NM. [Changes in the enzymatic activity in the myocardium of patients with idiopathic and secondary dilated cardiomyopathy]. Arkh Patol 1993; 55:69.
  52. Guazzi M, Polese A, Magrini F, et al. Negative influences of ascites on the cardiac function of cirrhotic patients. Am J Med 1975; 59:165.
  53. Wang RY, Alterman AI, Searles JS, McLellan AT. Alcohol abuse in patients with dilated cardiomyopathy. Laboratory vs clinical detection. Arch Intern Med 1990; 150:1079.
  54. Regan TJ. Alcoholic cardiomyopathy. Prog Cardiovasc Dis 1984; 27:141.
  55. Ettinger PO, Wu CF, De La Cruz C Jr, et al. Arrhythmias and the "Holiday Heart": alcohol-associated cardiac rhythm disorders. Am Heart J 1978; 95:555.
  56. Buckingham TA, Kennedy HL, Goenjian AK, et al. Cardiac arrhythmias in a population admitted to an acute alcoholic detoxification center. Am Heart J 1985; 110:961.
  57. Frost L, Vestergaard P. Alcohol and risk of atrial fibrillation or flutter: a cohort study. Arch Intern Med 2004; 164:1993.
  58. Guzzo-Merello G, Segovia J, Dominguez F, et al. Natural history and prognostic factors in alcoholic cardiomyopathy. JACC Heart Fail 2015; 3:78.
  59. Corović N, Duraković Z, Misigoj-Duraković M. Dispersion of the corrected QT and JT interval in the electrocardiogram of alcoholic patients. Alcohol Clin Exp Res 2006; 30:150.
  60. Fauchier L. Alcoholic cardiomyopathy and ventricular arrhythmias. Chest 2003; 123:1320.
  61. Elisaf M, Merkouropoulos M, Tsianos EV, Siamopoulos KC. Pathogenetic mechanisms of hypomagnesemia in alcoholic patients. J Trace Elem Med Biol 1995; 9:210.
  62. Elisaf M, Liberopoulos E, Bairaktari E, Siamopoulos K. Hypokalaemia in alcoholic patients. Drug Alcohol Rev 2002; 21:73.
  63. Piano MR. Alcoholic cardiomyopathy: incidence, clinical characteristics, and pathophysiology. Chest 2002; 121:1638.
  64. Mathews EC Jr, Gardin JM, Henry WL, et al. Echocardiographic abnormalities in chronic alcoholics with and without overt congestive heart failure. Am J Cardiol 1981; 47:570.
  65. Orlando E, Gennari P, Boari C. [Echocardiographic study of the left ventricle in chronic alcoholism]. Minerva Med 1980; 71:3235.
  66. Askanas A, Udoshi M, Sadjadi SA. The heart in chronic alcoholism: a noninvasive study. Am Heart J 1980; 99:9.
  67. Dancy M, Bland JM, Leech G, et al. Preclinical left ventricular abnormalities in alcoholics are independent of nutritional status, cirrhosis, and cigarette smoking. Lancet 1985; 1:1122.
  68. Kelbaek H, Eriksen J, Brynjolf I, et al. Cardiac performance in patients with asymptomatic alcoholic cirrhosis of the liver. Am J Cardiol 1984; 54:852.
  69. Fernández-Solà J, Nicolás JM, Paré JC, et al. Diastolic function impairment in alcoholics. Alcohol Clin Exp Res 2000; 24:1830.
  70. Francone M. Role of cardiac magnetic resonance in the evaluation of dilated cardiomyopathy: diagnostic contribution and prognostic significance. ISRN Radiol 2014; 2014:365404.
  71. Ocel JJ, Edwards WD, Tazelaar HD, et al. Heart and liver disease in 32 patients undergoing biopsy of both organs, with implications for heart or liver transplantation. Mayo Clin Proc 2004; 79:492.
  72. Milani A, Zaccaria R, Bombardieri G, et al. Cirrhotic cardiomyopathy. Dig Liver Dis 2007; 39:507.
  73. Møller S, Henriksen JH. Cirrhotic cardiomyopathy. J Hepatol 2010; 53:179.
  74. Zardi EM, Abbate A, Zardi DM, et al. Cirrhotic cardiomyopathy. J Am Coll Cardiol 2010; 56:539.
  75. Timoh T, Protano MA, Wagman G, et al. A perspective on cirrhotic cardiomyopathy. Transplant Proc 2011; 43:1649.
  76. Mukamal KJ, Tolstrup JS, Friberg J, et al. Alcohol consumption and risk of atrial fibrillation in men and women: the Copenhagen City Heart Study. Circulation 2005; 112:1736.
  77. La Vecchia LL, Bedogni F, Bozzola L, et al. Prediction of recovery after abstinence in alcoholic cardiomyopathy: role of hemodynamic and morphometric parameters. Clin Cardiol 1996; 19:45.
  78. Renault A, Mansourati J, Genet L, Blanc JJ. [Dilated cardiomyopathies in severe cardiac failure in chronic alcoholics: clinical course after complete withdrawal]. Rev Med Interne 1993; 14:942.
  79. Nethala V, Brown EJ Jr, Timson CR, Patcha R. Reversal of alcoholic cardiomyopathy in a patient with severe coronary artery disease. Chest 1993; 104:626.
  80. Demakis JG, Proskey A, Rahimtoola SH, et al. The natural course of alcoholic cardiomyopathy. Ann Intern Med 1974; 80:293.
  81. Mansourati J, Forneiro I, Genet L, et al. [Regression of dilated cardiomyopathy in a chronic alcoholic patient after abstinence from alcohol]. Arch Mal Coeur Vaiss 1990; 83:1849.
  82. Agatston AS, Snow ME, Samet P. Regression of severe alcoholic cardiomyopathy after abstinence of 10 weeks. Alcohol Clin Exp Res 1986; 10:386.
  83. Masani F, Kato H, Sasagawa Y, et al. [An echocardiographic study of alcoholic cardiomyopathy after total abstinence]. J Cardiol 1990; 20:627.
  84. Guillo P, Mansourati J, Maheu B, et al. Long-term prognosis in patients with alcoholic cardiomyopathy and severe heart failure after total abstinence. Am J Cardiol 1997; 79:1276.
  85. Nicolás JM, Fernández-Solà J, Estruch R, et al. The effect of controlled drinking in alcoholic cardiomyopathy. Ann Intern Med 2002; 136:192.
  86. Gavazzi A, De Maria R, Parolini M, Porcu M. Alcohol abuse and dilated cardiomyopathy in men. Am J Cardiol 2000; 85:1114.
  87. Prazak P, Pfisterer M, Osswald S, et al. Differences of disease progression in congestive heart failure due to alcoholic as compared to idiopathic dilated cardiomyopathy. Eur Heart J 1996; 17:251.