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重症酒精性肝炎的处置策略

刘华 韩涛

引用本文:
Citation:

重症酒精性肝炎的处置策略

DOI: 10.3969/j.issn.1001-5256.2014.02.007
基金项目: 

艾滋病和病毒性肝炎等重大传染病防治国家科技重大专项(2012ZX10002004-011); 天津市科委基金项目(12JCYBJC17300); 

详细信息
  • 中图分类号: R575.1

Treatment strategies for severe alcoholic hepatitis

Research funding: 

 

  • 摘要:

    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。

     

  • [1]PRNA K, RAHU K.Dramatic increase in alcoholic liver cirrhosis mortality in Estonia in 1992-2008[J].Alcohol Alcohol, 2010, 45 (6) :548-551.
    [2]LU XL, TAO M, LUO JY, et al.Epidemiology of alcohol and liver disease[J].Chin J Hepatol, 2002, 10 (6) :467-468. (in Chinese) 鲁晓岚, 陶明, 罗金燕, 等.饮酒与肝病流行病学调查[J].中华肝脏病杂志, 2002, 10 (6) :467-468.
    [3]LI YM.Epidemiological features of alcoholic liver disease[J].J Clin Hepatol, 2012, 15 (3) :180-182. (in Chinese) 厉有名.酒精性肝病的流行病学特点[J].实用肝脏病杂志, 2012, 15 (3) :180-182.
    [4] Fatty Liver and Alcoholic Liver Disease Study Group of the Chinese Liver Disease Association, Chinese Medical Association.Guidelines for prevention and treatment of alcoholic liver disease (revised version 2010) [J].J Clin Hepatol, 2010, 26 (3) :229-232. (in Chinese) 中华医学会肝病学分会脂肪肝和酒精性肝病学组.酒精性肝病诊疗指南 (2010年修订版) [J].临床肝胆病杂志, 2010, 26 (3) :229-232.
    [5]O'SHEA RS, DASARATHY S, MCCULLOUGH AJ.Practice Guideline Committee of the American Association for the Study of Liver Diseases, Practice Parameters Committee of the American College of Gastroenterology.Alcoholic liver disease[J].Hepatology, 2010, 51 (1) :307-328.
    [6]MATHURIN P, HADENGUE A, BATALLER R, et al.EASL clinical practical guidelines:management of alcoholic liver disease[J].J Hepatol, 2012, 57 (2) :399-420.
    [7]POTTS JR, GOUBET S, HENEGHAN MA, et al.Determinants of long-term outcome in severe alcoholic hepatitis[J].Aliment Pharmacol Ther, 2013, 38 (6) :584-595.
    [8]ADDOLORATO G, LEGGIO L, FERRULLI A, et al.Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis:randomised, doubleblind controlled study[J].Lancet, 2007, 370 (9603) :1915-1922.
    [9]MUZYK AJ, RIVELLI SK, GAGLIARDI JP.Defining the role of baclofen for the treatment of alcohol dependence:a systematic review of the evidence[J].CNS Drugs, 2012, 26 (1) :69-78.
    [10]LEGGIO L, FERRULLI A, ZAMBON A, et al.Baclofen promotes alcohol abstinence in alcohol dependent cirrhotic patients with hepatitis C virus (HCV) infection[J].Addict Behav, 2012, 37 (4) :561-564.
    [11]RICHARDS DA, HILL JJ, GASK L, et al.Clinical effectiveness of collaborative care for depression in UK primary care (CADET) :cluster randomised controlled trial[J].BMJ, 2013, 347:f4913.
    [12] REHM J, MATHERS C, POPOVA S, et al.Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders[J].Lancet, 2009, 373 (9682) :2223-2233.
    [13]UNGUR LA, NEUNER B, JOHN S, et al.Prevention and therapy of alcohol withdrawal on intensive care units:systematic review of controlled trials[J].Alcohol Clin Exp Res, 2013, 37 (4) :675-686.
    [14]PLANK LD, GANE EJ, PENG S, et al.Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis:a randomized 12-month trial[J].Hepatology, 2008, 48 (2) :557-566.
    [15]ALVAREZ MA, CABRE, LORENZO-ZU'N¨IGA V, et al.Combining steroids with enteral nutrition:a better therapeutic strategy for severe alcoholic hepatitis?Results of pilot study[J].Eur J Gastroentserol Hepatol, 2004, 16 (12) :1375-1380.
    [16]MEZEY E, POTTER JJ, RENNIE-TANKERSLEY L, et al.A randomized placebo controlled trial of vitamin E for alcoholic hepatitis[J].J Hepatol, 2004, 40 (1) :40-46.
    [17]LOUVET A, NAVEAU S, ABDELNOUR M, et al.The Lille model:a new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids[J].Hepatology, 2007, 45 (6) :1348-1354.
    [18]SRIKUREJA W, KYULO NL, RUNYON BA, et al.MELD score is a better prognostic model than Child-Turcotte-Pugh score or Discriminant Function score in patients with alcoholic hepatitis[J].J Hepatol, 2005, 42 (5) :700-706.
    [19]GUSTOT T, MAILLART E, BOCCI M, et al.Invasive aspergillosis in patients with severe alcoholic hepatitis[J].J Hepatol, 2014, 60 (2) :267-274.
    [20]LOUVET A, WARTEL F, CASTEL H, et al.Infection in patients with severe alcoholic hepatitis treated with steroids:early response to therapy is the key factor[J].Gastroenterology, 2009, 137 (2) :541-548.
    [21]KENDRICK SF, HENDERSON E, PALMER J, et al.Theophylline improves steroid sensitivity in acute alcoholic hepatitis[J].Hepatology, 2010, 52 (1) :126-131.
    [22]SIDHU SS, GOYAL O, SINGLA P, et al.Corticosteroid plus pentoxifylline is not better than corticosteroid alone for improving survival in severe alcoholic hepatitis (COPE trial) [J].Dig Dis Sci, 2012, 57 (6) :1664-1671.
    [23]ASSIMAKOPOULOS SF, THOMOPOULOS KC, LABROPOULOUKARATZA C.Pentoxifylline:a first line treatment option for severe alcoholic hepatitis and hepatorenal syndrome?[J].World J Gastroenterol, 2009, 15 (25) :3194-3195.
    [24]MATHURIN P, LOUVET A, DUHAMEL A, et al.Prednisolone with vs without pentoxifylline and survival of patients with severe alcoholic hepatitis:a randomized clinical trial[J].JAMA, 2013, 310 (10) :1033-1041.
    [25]SPAHR L, RUBBIA-BRANDT L, FROSSARD JL, et al.Combination of steroids with infliximab or placebo in severe alcoholic hepatitis:a randomized controlled pilot study[J].J Hepatol, 2002, 37 (4) :448-455.
    [26]SHARMA P, KUMAR A, SHARMA BC, et al.Infliximab monotherapy for severe alcoholic hepatitis and predictors of survival:an open label trial[J].J Hepatol, 2009, 50 (3) :584-591.
    [27]VERMA S, AJUDIA K, MENDLER M, et al.Prevalence of septic events, type 1 hepatorenal syndrome, and mortality in severe alcoholic hepatitis and utility of discriminant function and MELD score in predicting these adverse events[J].Dig Dis Sci, 2006, 51 (9) :1637-1643.
    [28]SALERNO F, CAZZANIGA M, MERLI M, et al.Diagnosis, treatment and survival of patients with hepatorenal syndrome:a survey on daily medical practice[J].J Hepatol, 2011, 55 (6) :1241-1248.
    [29]BOYER TD, SANYAL AJ, GARCIA-TSAO G, et al.Predictors of response to terlipressin plus albumin in hepatorenal syndrome (HRS) type 1:relationship of serum creatinine to hemodynamics[J].J Hepatol, 2011, 55 (2) :315-321.
    [30]TESTINO G, LEONE S, FERRO C, et al.Severe acute alcoholic hepatitis and hepatorenal syndrome:role of transjugular intrahepatic portosystemic stent shunt[J].J Med Life, 2012, 5 (2) :203-205.
    [31]HORIE Y.Granulocytapheresis and plasma exchange for severe alcoholic hepatitis[J].J Gastroenterol Hepatol, 2012, 27 (Suppl2) :99-103.
    [32]SEN S, MOOKERJEE RP, CHESHIRE LM, et al.Albumin dialysis reduces portal pressure acutely in patients with severe alcoholic hepatitis[J].J Hepatol, 2005, 43 (1) :142-148.
    [33] MATHURIN P, MORENO C, SAMUEL D, et al.Early liver transplantation for severe alcoholic hepatitis[J].N Engl J Med, 2011, 365 (19) :1790-1800.
    [34]DUREJA P, LUCEY MR.The place of liver transplantation in the treatment of severe alcoholic hepatitis[J].J Hepatol, 2010, 52 (5) :759-764.
    [35]SINGAL AK, KAMATH PS, GORES GJ, et al.Alcoholic Hepatitis:Current challenges and future directions[J].Clin Gastroenterol Hepatol, 2013 Jun 28.[Epub ahead of print]
    [36]AMINI M, RUNYON BA.Alcoholic hepatitis 2010:a clinician's guide to diagnosis and therapy[J].World J Gastroenterol, 2010, 16 (39) :4905-4912.
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  • 收稿日期:  2013-11-05
  • 出版日期:  2014-02-20
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