酒精性肝病治疗研究进展

Advances in alcoholic liver disease treatment

目前,长期过度摄入酒精而引发的酒精性肝病已经成为一个社会性的健康问题,给患者、家庭及社会带来了极大的经济负担。酒精性肝病包括酒精性脂肪肝、酒精性肝炎、肝硬化以及肝癌等。酒精性肝病的诊断一般基于临床上的症状,如饮酒史、肝病指标及临床化验指标等。目前酒精性肝病的治疗最重要的是戒酒,再根据病情采取相应的治疗措施,主要的治疗手段包括药物治疗、精神治疗及外科肝移植治疗等。严重的酒精性肝病临床上推荐使用皮质类固醇或己酮可可碱。干细胞治疗是肝硬化患者的一个可能的治疗措施。肝移植除了合适的肝脏供体,移植后使用的免疫抑制剂可能导致新的癌症的发生。新型的安全高效的病理生理主导的治疗方法是治疗酒精性肝病的必然趋势,可能的靶点包括CXC细胞因子、IL-22、TNF受体超家族、补体和脂多糖(LPS)等。

Alcoholic liver diseases （ALD） which is associated with excess consumption of alcohol, is a major healthcare problem and brings great economic burden to patients’ family and society. ALD include alcoholic fatty liver, alcoholic hepatitis, cirrhosis, and the development of hepatocellular carcinoma. The diagnosis of ALD is according to the clinical features, such as history of excess alcohol consume, evidence of liver disease, and laboratory findings. The most important and effective treatment for ALD is abstinence, and according to the stage of the disease the treatment plan varies. Now, the treatments for alcoholic liver diseases include abstinence, nutritional therapy, pharmacological therapy, psychotherapy, and liver transplantation. For severe alcoholic hepatitis, corticosteroid or pentoxifylline are recommended based on the guidelines. The suitable donor is essential for liver transplantation, and immunosuppressive drugs that are used after transplantation may cause new cancers. Stem cell therapy could be a promising strategy for patients with liver cirrhosis. Novel pathophysiology-oriented therapies are needed for patients with ALD in the future, including CXC chemokines, IL-22, TNF receptor superfamily, complement and LPS.