Alcoholic Liver Disease: Pathogenesis and Current Management
Alcoholic Liver Disease: Pathogenesis and Current Management
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发表时间：
2017
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通讯作者：
N. Osna;T. Donohue;K. Kharbanda
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作者：
N. Osna;T. Donohue;K. Kharbanda
过度饮酒是一个全球性的健康问题。由于肝脏是酒精代谢的主要部位，因此大量饮酒对肝脏的组织损伤程度最大。慢性和过量饮酒会产生广泛的肝脏病变，其中最具特征的是脂肪变性、肝炎和纤维化/肝硬化。脂肪变性是对大量饮酒的最早反应，其特征在于脂肪在肝细胞中的沉积。脂肪变性可以进展为脂肪性肝炎，这是一种更严重的炎性肝损伤。肝脏疾病的这个阶段可能导致纤维化的发展，在此期间存在细胞外基质蛋白的过度沉积。纤维化反应始于活性细胞周围纤维化，其可进展为肝硬化，其特征在于过度的肝瘢痕形成、血管改变和最终的肝衰竭。在问题饮酒者中，大约35%的人发展为晚期肝病，因为许多疾病修饰物加剧，减缓或阻止酒精性肝病的进展。目前仍没有FDA批准的药物或营养疗法用于治疗酒精性肝病患者。停止饮酒（即，禁欲）是治疗的一个组成部分。肝移植仍然是终末期酒精性肝病患者的救命策略。
Excessive alcohol consumption is a global healthcare problem. The liver sustains the greatest degree of tissue injury by heavy drinking because it is the primary site of ethanol metabolism. Chronic and excessive alcohol consumption produces a wide spectrum of hepatic lesions, the most characteristic of which are steatosis, hepatitis, and fibrosis/cirrhosis. Steatosis is the earliest response to heavy drinking and is characterized by the deposition of fat in hepatocytes. Steatosis can progress to steatohepatitis, which is a more severe, inflammatory type of liver injury. This stage of liver disease can lead to the development of fibrosis, during which there is excessive deposition of extracellular matrix proteins. The fibrotic response begins with active pericellular fibrosis, which may progress to cirrhosis, characterized by excessive liver scarring, vascular alterations, and eventual liver failure. Among problem drinkers, about 35 percent develop advanced liver disease because a number of disease modifiers exacerbate, slow, or prevent alcoholic liver disease progression. There are still no FDA-approved pharmacological or nutritional therapies for treating patients with alcoholic liver disease. Cessation of drinking (i.e., abstinence) is an integral part of therapy. Liver transplantation remains the life-saving strategy for patients with end-stage alcoholic liver disease.