Alcoholic liver disease.
Alcoholic liver disease.
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DOI：
10.4254/wjh.v4.i3.81
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发表时间：
2009-01-01
影响因子：
--
通讯作者：
Svestka, T
中科院分区：
文献类型：
--
作者：
Bruha, R;Dvorak, K;Svestka, T
酒精使用障碍影响着全世界数百万人。饮酒与肝病死亡率直接相关，并导致社会和经济成本上升。酒精性肝病 (ALD) 可能表现为急性受累（酒精性肝炎）或慢性肝病（脂肪变性、脂肪性肝炎、纤维化和肝硬化）。酒精性肝病的严重程度和预后取决于饮酒的量、方式和持续时间，以及肝脏炎症的存在、饮食、营养状况和个体的遗传倾向。虽然脂肪变性几乎是一种完全良性的疾病，但肝硬化与显着的发病率、死亡率和预期寿命缩短有关。晚期肝硬化患者的中位生存期为1-2年。严重急性酒精性肝炎 (AH) 的死亡率高达 50%。尽管基于证据的数据仍然相互矛盾，但它已通过皮质类固醇、己酮可可碱和肠内营养进行治疗。一些作者认为己酮可可碱可能是严重 AH 患者更好的一线治疗。绝对戒酒是任何治疗急性或慢性 ALD 的基本条件，其他治疗程序具有支持性且意义值得怀疑。阿坎酸似乎是支持酒精依赖患者持续戒酒的有效治疗策略。晚期肝硬化患者如果明显戒酒，可以考虑进行肝移植，从而显着延长预期寿命。预防酒精性肝病的关键是预防酗酒，而对于主动酗酒者预防肝损伤在临床上并不适用。长期大量摄入酒精会导致多种器官受损，其中肝脏是最容易受到影响的器官。在发达国家，肝病死亡率与饮酒量成正比。每天30克纯酒精被视为“安全”剂量。酒精性肝病可能表现为慢性疾病（脂肪变性、脂肪性肝炎、纤维化和肝硬化）或急性受累（酒精性肝炎）。虽然脂肪变性是一种相对良性的疾病，但肝硬化的存在意味着预期寿命的大幅缩短。肝硬化的实际阶段取决于是否存在并发症——门静脉高压伴食管静脉曲张出血、腹水或肝性脑病。晚期肝硬化患者的中位生存时间为1-2年。严重的酒精性肝炎死亡率高达50%。绝对戒酒是任何治疗酒精性肝病的必要条件，其他治疗程序的支持性和意义值得怀疑。皮质类固醇可用于治疗严重的酒精性肝炎。肝硬化阶段的治疗与任何其他病因的肝硬化相似。明确禁欲的肝硬化患者可以考虑进行移植，从而显着延长预期寿命。
Alcohol use disorders affect millions of individuals worldwide. Alcohol consumption is directly associated with liver disease mortality and accounts for elevated social and economic costs. Alcoholic liver disease (ALD) may take the form of acute involvement (alcoholic hepatitis) or chronic liver disease (steatosis, steatohepatitis, fibrosis and cirrhosis). The severity and prognosis of alcohol-induced liver disease depends on the amount, pattern and duration of alcohol consumption, as well as on the presence of liver inflammation, diet, nutritional status and genetic predisposition of an individual. While steatosis is an almost completely benign disease, liver cirrhosis is associated with marked morbidity, mortality and life expectancy shortening. The median survival of patients with advanced cirrhosis is 1-2 years. Severe acute alcoholic hepatitis (AH) is associated with mortality as high as 50%. It has been managed with corticoids, pentoxifylline and enteral nutrition, although evidence based data are still conflicting. Some author suggest that pentoxifylline could be a better first-line treatment in patients with severe AH. Absolute abstinence is a basic condition for any treatment of acute or chronic ALD, the other therapeutical procedure being of a supportive nature and questionable significance. Acamprosate appears to be an effective treatment strategy for supporting continuous abstinence in alcohol dependent patients. Patients with advanced liver cirrhosis who demonstrably abstain can be considered for liver transplantation, which leads to a markedly prolonged life expectancy. The crucial step in ALD prevention is in the prevention of alcohol abuse, whereas the prevention of liver injury in active alcohol abusers is not clinically applicable.Chronic intake of large quantities of alcohol causes damage to many organs, the liver being the most often affected one. In advanced countries, mortality due to liver diseases is directly proportional to alcohol consumption. 30 g of pure alcohol per day is regarded as a "safe" dose. Alcoholic liver disease may take the form of chronic illness (steatosis, steato-hepatitis, fibrosis and cirrhosis) or acute involvement (alcoholic hepatitis). Whereas steatosis is a relatively benign illness, the presence of cirrhosis of the liver means major life expectancy shortening. The actual stage of cirrhosis depends on the presence of complications--portal hypertension with bleeding oesophageal varices, ascites or hepatic encephalopathy. The median survival time of patients with advanced cirrhosis is 1-2 years. Serious alcoholic hepatitis has a mortality record of up to 50%. Absolute abstinence is a sine qua non condition for any treatment of alcoholic liver disease, the other therapeutic procedure are of a supportive nature and questionable significance. Corticoids can be used in the management of serious alcoholic hepatitis. Treatment in the stage of liver cirrhosis is similar to that in cirrhosis of any other aetiology. Cirrhotic patients who demonstrably abstain can be considered for transplantation leading to a markedly prolonged life expectancy.