酒精滥用和血液系统疾病
- Author
- Stanley L Schrier, MD
Stanley L Schrier, MD
- Editor-in-Chief — Hematology
- Section Editor — Myeloproliferative Disorders; Red Blood Cell Disorders
- Professor of Medicine
- Stanford University School of Medicine
- Section Editor
- William C Mentzer, MD
William C Mentzer, MD
- Section Editor — Red Cell Disorders
- Professor of Pediatrics
- University of California, San Francisco
- Deputy Editor
- Stephen A Landaw, MD, PhD
Stephen A Landaw, MD, PhD
- Deputy Editor — Hematology
- Associate Clinical Professor of Medicine
- Harvard Medical School
引言
酒精滥用一般定义为长期酒精摄入量超过80g/d[1]。这相当于以下任一种日摄取量：约250mL烈性酒、超过500mL的加强葡萄酒、1瓶(750mL)佐餐葡萄酒或1.5L啤酒(1罐/1瓶为12盎司，共计4罐/4瓶)。
酒精滥用可对血液系统可产生多种影响，包括大红细胞症伴或不伴贫血、白细胞减少和/或血小板减少。其发生机制尚不完全清楚。对造血细胞的直接毒性作用、膜磷脂异常和干扰叶酸利用均可能与之相关[2,3]。
酒精滥用的血液学表现将在此讨论。酒精相关性疾病的一般内容将单独讨论。 (参见“酒精性肝病的发病机制”和“酒精性脂肪性肝病和酒精性肝硬化的临床表现和诊断”和“成人乙醇中毒”)
酒精中毒的机制
酒精对造血作用的不良影响可能部分通过酒精(乙醇)代谢物介导。摄入的乙醇在肝脏内部分由乙醇脱氢酶代谢，该酶将乙醇氧化为乙醛，同时将烟酰胺腺嘌呤二核苷酸(nicotinamide adenine dinucleotide, NAD)还原为还原型烟酰胺腺嘌呤二核苷酸(reduced form of nicotinamide-adenine dinucleotide, NADH)。 (参见“酒精性肝病的发病机制”，关于‘乙醇代谢’一节)
已有人提出，酒精的部分血液学毒性可能由乙醛引起[2,3]。乙醛可产生红细胞(red blood cell, RBC)蛋白-乙醛加合物[4]，这些加合物可引起针对这些修饰蛋白的免疫反应。事实上，已在有大红细胞的酗酒者中发现有抗乙醛-蛋白加合物的IgA和IgM[5]。 (参见下文‘大红细胞症’)
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To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: 2017-06 . | This topic last updated: 2017-06-19.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References- Savage D, Lindenbaum J. Anemia in alcoholics. Medicine (Baltimore) 1986; 65:322.
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