酒精性肝炎临床治疗进展

Progress in the clinical treatment of alcoholic hepatitis

酒精性肝炎是一种严重危及生命的全身炎症反应综合征, 在世界范围内具有较高的发病率和病死率, 严重程度从无症状的肝脏生物化学紊乱到暴发性肝衰竭或死亡, 但有效的治疗方法却很少。Maddrey判别函数不仅能预测酒精性肝炎的短期病死率, 还能指导临床医生选择适当的特异性治疗方案。戒酒、营养支持、心理疏导和感染的防治仍然是治疗酒精性肝炎的基石。当患者食欲良好且血清肌酐水平正常时, 皮质类固醇仍然是治疗的主要手段, 早期肝移植是对类固醇无反应患者的唯一救命选择。新的研究将肠道微生物群作为酒精性肝炎的重要治疗靶点, N-乙酰半胱氨酸、粒细胞集落刺激因子和美他多辛, 可以作为辅助治疗, 对患者生存有积极影响。

Alcoholic hepatitis is a severe and life-threatening systemic inflammatory response syndrome,which has a high incidence and mortality rate worldwide.The severity ranges from asymptomatic liver biochemical disturbances to fulminant liver failure or death;however,there are few effective therapeutic interventions.Maddrey discriminant function not only predicts short-term mortality,but it also guides clinicians to choose appropriate alcoholic hepatitis-specific treatments.A Icohol abstinence,nutritional support,psychological counseling,and infection prevention remain the cornerstones for alcoholic hepatitis treatment.Corticosteroids remain the mainstay of treatment when patients have a good appetite and normal serum creatinine levels,but early liver transplantation is the only life-saving option for steroid-unresponsive patients.New studies have found that gut microbiota is an important therapeutic targets in patients with alcohol hepatitis,and N-acetylcysteine,granulocyte colony-stimulating factor,and metadoxine as adjunctive therapy have a positive effect on patient survival.