重症酒精性肝炎诊治新观点

被引:1
作者
朱疆依
杨彩丰
韩英
机构
[1] 第四军医大学第一附属医院
关键词
酒精性肝炎,重症; 马德里判别函数; 糖皮质激素;
D O I
暂无
中图分类号
R575.1 [肝炎];
学科分类号
100201 [内科学];
摘要
酒精性肝炎(AH)一直是肝衰竭常见、威胁生命的原因之一,尤其是重症酒精性肝炎(SAH)。在临床诊疗中为了早期检测高危、预后差的患者,需要灵活利用多种预后评分系统指导或调整治疗。积极戒酒、营养支持、对症处理相应并发症,可为SAH患者后续治疗赢得时间。糖皮质激素(CS)应用于SAH患者的治疗,使SAH的病死率有了改善,但应合理评估病情程度,把握应用指征和个体化治疗。乙酮可可碱(PTX)已被多数指南推荐为CS治疗禁忌时(尤其是伴有肝肾综合征时)的一线治疗药物,而抗氧化治疗、分子吸附剂再循环系统、粒细胞分离技术等的应用,还需要进行更深一步的临床研究。对于预后较差、药物治疗无反应的SAH患者,早期行肝移植可能可以提高患者的生存率。
引用
收藏
页码:934 / 938
页数:5
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共 22 条
[1]
Pentoxifylline versus prednisolone for severe alcoholic hepatitis:A randomized controlled trial[J] Binay Krishna De;Subhabrata Gangopadhyay;Deep Dutta;Sumanta Das Baksi;Adyapad Pani;Pramit Ghosh; World Journal of Gastroenterology 2009,
[2]
The Utility of Scoring Systems in Predicting Early and Late Mortality in Alcoholic Hepatitis: Whose Score Is It Anyway?[J] Naaventhan Palaniyappan;Venkataraman Subramanian;Vidyasagar Ramappa;Stephen D. Ryder;Philip Kaye;Guruprasad P. Aithal;Neil Guha <journal-title>International Journal of Hepatology 2012,
[3]
EASL Clinical Practical Guidelines: Management of Alcoholic Liver Disease[J] European Association for the Study of the Liver Journal of Hepatology 2012,
[4]
Corticosteroid Plus Pentoxifylline Is Not Better than Corticosteroid Alone for Improving Survival in Severe Alcoholic Hepatitis (COPE Trial)[J] Sandeep Sidhu;Omesh Goyal;Preeti Singla;Dinesh Gupta;Ajit Sood;Rajoo Chhina;Ravinder Soni Digestive Diseases and Sciences 2012,
[5]
Corticosteroids or non-corticosteroids: a fresh perspective on alcoholic hepatitis treatment[J] Fei Wang;Bing-Yuan Wang Hepatobiliary & Pancreatic Diseases International 2011,
[6]
Alcoholic Hepatitis: Prognostic Models and Treatment[J] Ashwani K. Singal;Vijay H. Shah Gastroenterology Clinics of North America 2011,
[7]
Infection in Patients With Severe Alcoholic Hepatitis Treated With Steroids: Early Response to Therapy Is the Key Factor[J] Alexandre Louvet;Faustine Wartel;Hélène Castel;Sébastien Dharancy;Antoine Hollebecque;Valérie Canva–Delcambre;Pierre Deltenre;Philippe Mathurin Gastroenterology 2009,
[8]
A Randomized; Double-Blinded; Placebo-Controlled Multicenter Trial of Etanercept in the Treatment of Alcoholic Hepatitis[J] Nicholas C. Boetticher;Craig J. Peine;Paul Kwo;Gary A. Abrams;Tushar Patel;Bashar Aqel;Lisa Boardman;Gregory J. Gores;William S. Harmsen;Craig J. McClain;Patrick S. Kamath;Vijay H. Shah Gastroenterology 2008,
[9]
Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids[J] Alexandre Louvet;Emmanuel Diaz;Sébastien Dharancy;Hugues Coevoet;Frédéric Texier;Thierry Thévenot;Pierre Deltenre;Valérie Canva;Christophe Plane;Philippe Mathurin Journal of Hepatology 2007,
[10]
A randomized trial of antioxidant therapy alone or with corticosteroids in acute alcoholic hepatitis[J] Stephen Stewart;Martin Prince;Margaret Bassendine;Mark Hudson;Oliver James;David Jones;Chris Record;Christopher P. Day Journal of Hepatology 2007,