酒精性肝炎临床诊断的再思考

Clinical diagnosis of alcoholic hepatitis

根据酒精性肝炎(AH)和重症AH的概念、临床特征、预后等的明显差异,建议将AH明确区分为轻症AH和重症AH。住院的酒精性肝病(ALD)患者的疾病谱,肝硬化占绝大多数,同时轻症AH和重症AH共占比15%左右。重症AH包含酒精性肝衰竭;重症AH是临床诊断,而酒精性脂肪性肝炎是病理诊断。重症AH欧美国家的临床诊断标准趋于一致,而2018年中国指南与欧美国家不一致。

Based on the significant differences in definition, clinical features, and prognosis between alcoholic hepatitis (AH) and severe AH, it is recommended to classify AH into mild and severe AH. As for the disease spectrum of hospitalized patients with alcoholic liver disease, most patients have liver cirrhosis, and about 15% have mild or severe AH. Alcoholic liver failure belongs to the category of severe AH. Severe AH is a clinical diagnosis, while alcoholic steatohepatitis is a pathological diagnosis. The clinical diagnostic criteria for severe AH tend to be consistent in European and the United States of America, but the Chinese guideline released in 2018 is not consistent with the guidelines from western countries.