Alcoholic liver disease
Alcoholic liver disease
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DOI：
10.1038/s41572-018-0014-7
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发表时间：
2018-08-16
影响因子：
81.5
通讯作者：
Tsukamoto, Hidekazu
中科院分区：
文献类型：
--
作者：
Seitz, Helmut K.;Bataller, Ramon;Tsukamoto, Hidekazu
酒精性肝病（ALD）是世界范围内最常见的慢性肝病类型。ALD可以从酒精性脂肪肝（AFL）发展为以肝脏炎症为特征的酒精性脂肪性肝炎（ASH）。慢性ASH最终会导致纤维化和肝硬化，在某些情况下会导致肝细胞癌（HCC）。此外，严重的ASH（伴或不伴肝硬化）可导致酒精性肝炎，这是ALD的急性临床表现，与肝功能衰竭和高死亡率相关。大多数人每天消耗> 40克酒精发展AFL;然而，只有一小部分人会发展为更晚期的疾病。遗传、表观遗传和非遗传因素可以解释ALD表型的个体间差异。ALD的发病机制包括脂肪变性、氧化应激、乙酰丙酮酸介导的毒性以及细胞因子和趋化因子诱导的炎症反应。ALD的诊断包括评估患者的酒精使用障碍和晚期肝病的体征。AFL和肝纤维化的程度可以通过超声、瞬时弹性成像、MRI、血清生物标志物测量和肝活检组织学来确定。通过心身干预实现戒酒是ALD所有阶段的最佳治疗方法。在晚期疾病的情况下，如肝硬化或HCC，可能需要肝移植。因此，迫切需要新的治疗方法。
Alcoholic liver disease (ALD) is the most prevalent type of chronic liver disease worldwide. ALD can progress from alcoholic fatty liver (AFL) to alcoholic steatohepatitis (ASH), which is characterized by hepatic inflammation. Chronic ASH can eventually lead to fibrosis and cirrhosis and in some cases hepatocellular cancer (HCC). In addition, severe ASH (with or without cirrhosis) can lead to alcoholic hepatitis, which is an acute clinical presentation of ALD that is associated with liver failure and high mortality. Most individuals consuming > 40 g of alcohol per day develop AFL; however, only a subset of individuals will develop more advanced disease. Genetic, epigenetic and non-genetic factors might explain the considerable interindividual variationin ALD phenotype. The pathogenesis of ALD include she paticsteatosis, oxidativestress, acetaldehyde-mediated toxicity and cytokine and chemokine-induced inflammation. Diagnosis of ALD involves assessing patients for alcohol use disorder and signs of advanced liver disease. The degree of AFL and liver fibrosis can be determined by ultrasonography, transient elastography, MRI, measurement of serum biomarkers and liver biopsy histology. Alcohol abstinence achieved by psychosomatic intervention is the best treatment for all stages of ALD. In the case of advanced disease such as cirrhosis or HCC, liver transplantation may be required. Thus, new therapies are urgently needed.