ACG Clinical Guideline: Alcoholic Liver Disease.
ACG Clinical Guideline: Alcoholic Liver Disease.
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DOI：
10.1038/ajg.2017.469
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发表时间：
2018-03
期刊：
影响因子：
--
通讯作者：
Shah VH
中科院分区：
文献类型：
--
作者：
Singal AK;Bataller R;Ahn J;Kamath PS;Shah VH
酒精性肝病（ALD）包括临床-组织学谱，包括脂肪肝、酒精性肝炎（AH）和肝硬化及其并发症。大多数患者在晚期被诊断，关于早期疾病患者的患病率和特征的数据有限。ALD的诊断需要记录慢性重度酒精使用并排除其他肝病原因。长期禁欲是预防疾病进展的最有效策略。AH表现为黄疸的快速发作或恶化，在严重病例中，当死亡风险（取决于肝外器官衰竭的数量）在1个月时可能高达20-50%时，可能会转变为急性慢性肝功能衰竭。皮质类固醇在约一半的重度AH治疗患者中提供短期生存获益，长期死亡率与基础肝病的严重程度相关，并依赖于戒酒。ALD住院患者的一般措施包括肝病并发症的住院管理，酒精戒断综合征的管理，感染监测和早期有效的抗生素治疗，营养补充和潜在的酒精使用障碍的治疗。肝移植是晚期酒精性肝硬化患者的一种确定性治疗选择，也可考虑用于对药物治疗无反应的选定AH患者。临床上存在未满足的需求，即为ALD患者开发更有效和更安全的疗法。
Alcoholic liver disease (ALD) comprises a clinical-histologic spectrum including fatty liver, alcoholic hepatitis (AH), and cirrhosis with its complications. Most patients are diagnosed at advanced stages and data on the prevalence and profile of patients with early disease are limited. Diagnosis of ALD requires documentation of chronic heavy alcohol use and exclusion of other causes of liver disease. Prolonged abstinence is the most effective strategy to prevent disease progression. AH presents with rapid onset or worsening of jaundice, and in severe cases may transition to acute on chronic liver failure when the risk for mortality, depending on the number of extra-hepatic organ failures, may be as high as 20–50% at 1 month. Corticosteroids provide short-term survival benefit in about half of treated patients with severe AH and long-term mortality is related to severity of underlying liver disease and is dependent on abstinence from alcohol. General measures in patients hospitalized with ALD include inpatient management of liver disease complications, management of alcohol withdrawal syndrome, surveillance for infections and early effective antibiotic therapy, nutritional supplementation, and treatment of the underlying alcohol-use disorder. Liver transplantation, a definitive treatment option in patients with advanced alcoholic cirrhosis, may also be considered in selected patients with AH cases, who do not respond to medical therapy. There is a clinical unmet need to develop more effective and safer therapies for patients with ALD.
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