酒精性肝炎的诊断与治疗策略

摘要

Alcoholic hepatitis (AH), especially severe alcoholic hepatitis (SAH), has been one of the most common causes of liver failure that poses a threat to human life. Patients often have a long history of heavy alcohol use. Liver injury usually presents a sub-acute course and develops significant clinical manifestations after several weeks or months. Basic treatments of AH include abstaining from alcohol, nutrition support and anti-inflammatory and liver-protecting drugs. The use of corticosteroids (CS) in SAH is still in controversy, focusing on its risks and benefits. How to evaluate the degree of the disease, choose indications and give individualized treatment are important. In view of the risks of CS therapy, more attention has been paid to pentoxifylline, which has been a first-line drug for SAH. Baclofen can reduce the thirst for alcohol and has become one of the important measures in later management of AH.%酒精性肝炎(alcoholic hepatitis,AH)尤其是重症酒精性肝炎(severe alcoholic hepatitis,SAH)一直是肝衰竭常见的、威胁生命的原因之一.患者常有长期大量饮酒史,肝损伤通常为亚急性,经过数周或数月才出现明显的临床表现.基本的治疗包括戒酒、营养支持和抗炎保肝.SAH的糖皮质激素治疗一直处于争论之中,主要聚焦于风险和益处,如何评估病情程度、把握应用指征和个体化治疗非常重要.考虑到糖皮质激素治疗的多种风险,己酮可可碱越来越受到人们的关注,已成为SAH的一线治疗药物.巴氯芬可减轻患者对酒精的渴求,是AH后期管理的重要措施之一.