Treatment of alcoholic liver disease.
Treatment of alcoholic liver disease.
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DOI：
10.1177/1756283x10378925
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发表时间：
2011-01-01
影响因子：
4.2
通讯作者：
McClain, Craig J
中科院分区：
文献类型：
--
作者：
Frazier, Thomas H;Stocker, Abigail M;McClain, Craig J
酒精性肝病（ALD）仍然是美国和世界范围内肝脏相关死亡的主要原因。ALD的正确诊断通常可以在临床基础上结合血液检查进行，通常不需要肝活检。戒酒是ALD治疗的标志，营养治疗是治疗干预的第一线。类固醇在中重度酒精性肝炎患者中的作用越来越被接受，但需要在1周时评估患者的治疗效果。喷替福林似乎对伴有肾功能不全/肝肾综合征的ALD患者特别有效。生物制剂如特异性抗肿瘤坏死因子一直令人失望，可能不应该在临床试验环境之外使用。移植对于已经停止饮酒（通常≥6个月）的终末期ALD患者是有效的，长期移植物和患者生存率都很好。
Alcoholic liver disease (ALD) remains a major cause of liver-related mortality in the US and worldwide. The correct diagnosis of ALD can usually be made on a clinical basis in conjunction with blood tests, and a liver biopsy is not usually required. Abstinence is the hallmark of therapy for ALD, and nutritional therapy is the first line of therapeutic intervention. The role of steroids in patients with moderate to severe alcoholic hepatitis is gaining increasing acceptance, with the caveat that patients be evaluated for the effectiveness of therapy at 1 week. Pentoxifylline appears to be especially effective in ALD patients with renal dysfunction/hepatorenal syndrome. Biologics such as specific anti-TNFs have been disappointing and should probably not be used outside of the clinical trial setting. Transplantation is effective in patients with end-stage ALD who have stopped drinking (usually for ≥6 months), and both long-term graft and patient survival are excellent.