重症酒精性肝炎的处置策略

Treatment strategies for severe alcoholic hepatitis

重症酒精性肝炎(SAH)作为酒精性肝病中的危重症,患者多在酒精性肝炎的基础上合并肝衰竭,并发症多,病死率高,亟需优化的治疗策略以提高患者生存期。对于SAH而言,戒酒是治疗的基础,营养支持也是必要的;糖皮质激素是目前重要的治疗药物,临床上可依据Maddrey判别函数、Lille及MELD评分进行病情评估与药物疗效评价;感染及肝肾综合征等并发症的防治也是应当予以关注的;严重者可考虑早期肝移植。

Severe alcoholic hepatitis （SAH） is a severe manifestation of alcoholic liver disease, which is associated with high mortality and presence of liver failure or complications, so optimized treatment strategies are needed to improve the survival of SAH patients. For SAH, the management is based on alcohol abstinence, and nutritional support is also necessary ; glucocorticoid therapy is still the key of treatment. The patient~ condition and treatment outcome can be evaluated according to the Maddrey discriminant function and Lille and MELD scores. Attention should also be paid to the prevention and treatment of complications such as infection and hepatorenal syndrome. Early liver trans- plantation can be considered for severe patients.