从临床角度看酒精性肝病

V. Sevastianos, S. Dourakis
{"title":"从临床角度看酒精性肝病","authors":"V. Sevastianos, S. Dourakis","doi":"10.2015/hc.v11i4.756","DOIUrl":null,"url":null,"abstract":"Liver disease is responsible for more than 55% of deaths resulting from alcohol abuse, while the prevalence of alcoholic liver disease (ALD) is closely correlated with per capita alcohol consumption. ALD represents a wide range of histological changes ranging from simple steatosis to heavier forms of liver injury including alcoholic hepatitis, cirrhosis and/or concurrent development of hepatocellular carcinoma. These alterations of the hepatic parenchyma do not necessarily reflect distinct stages of liver disease progression, but rather a continuum relating to histological changes that may be observed simultaneously in the same patient. The fact that only 35% of patients with heavy alcohol abuse develop advanced stages of liver disease, suggests that in the pathogenesis of ALD a number of other factors are involved that include gender, obesity, drinking patterns, dietary factors, non-sex-linked genetic factors and smoking. Also, long-term drinking can affect synergistically with hepatitis B or C and/or the human immunodeficiency virus, the non-alcoholic fatty liver disease and hepatic disorders such as hemochromatosis. The diagnosis of ALD is based on a combination of findings, including the history of significant alcohol consumption, the clinical evidence of the concomitant liver injury supported by the resultant histological, imaging and laboratory findings. A beneficial effect of alcoholic hepatitis treatment with corticosteroids is observed in patients with encephalopathy or with poor prognosis based on the various grading and prognostic systems of gravity, while the harmful effect is prominent in patients with milder disease, as they manifest an increased risk of infections compared with those not receiving corticosteroids. In patients with alcoholic hepatitis that cannot take corticosteroids for various reasons and in those with the onset of functional renal failure (“hepatorenal syndrome”), use of pentoxifylline is recommended.","PeriodicalId":91266,"journal":{"name":"Hospital chronicles = Nosokomeiaka chronika","volume":"11 1","pages":"200-210"},"PeriodicalIF":0.0000,"publicationDate":"2017-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Alcoholic Liver Disease from the Clinical Point of View\",\"authors\":\"V. Sevastianos, S. Dourakis\",\"doi\":\"10.2015/hc.v11i4.756\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Liver disease is responsible for more than 55% of deaths resulting from alcohol abuse, while the prevalence of alcoholic liver disease (ALD) is closely correlated with per capita alcohol consumption. ALD represents a wide range of histological changes ranging from simple steatosis to heavier forms of liver injury including alcoholic hepatitis, cirrhosis and/or concurrent development of hepatocellular carcinoma. These alterations of the hepatic parenchyma do not necessarily reflect distinct stages of liver disease progression, but rather a continuum relating to histological changes that may be observed simultaneously in the same patient. The fact that only 35% of patients with heavy alcohol abuse develop advanced stages of liver disease, suggests that in the pathogenesis of ALD a number of other factors are involved that include gender, obesity, drinking patterns, dietary factors, non-sex-linked genetic factors and smoking. Also, long-term drinking can affect synergistically with hepatitis B or C and/or the human immunodeficiency virus, the non-alcoholic fatty liver disease and hepatic disorders such as hemochromatosis. The diagnosis of ALD is based on a combination of findings, including the history of significant alcohol consumption, the clinical evidence of the concomitant liver injury supported by the resultant histological, imaging and laboratory findings. A beneficial effect of alcoholic hepatitis treatment with corticosteroids is observed in patients with encephalopathy or with poor prognosis based on the various grading and prognostic systems of gravity, while the harmful effect is prominent in patients with milder disease, as they manifest an increased risk of infections compared with those not receiving corticosteroids. In patients with alcoholic hepatitis that cannot take corticosteroids for various reasons and in those with the onset of functional renal failure (“hepatorenal syndrome”), use of pentoxifylline is recommended.\",\"PeriodicalId\":91266,\"journal\":{\"name\":\"Hospital chronicles = Nosokomeiaka chronika\",\"volume\":\"11 1\",\"pages\":\"200-210\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2017-03-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Hospital chronicles = Nosokomeiaka chronika\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2015/hc.v11i4.756\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hospital chronicles = Nosokomeiaka chronika","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2015/hc.v11i4.756","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

肝脏疾病导致55%以上的酒精滥用死亡,而酒精性肝病(ALD)的患病率与人均饮酒量密切相关。ALD代表了广泛的组织学变化,从简单的脂肪变性到更严重的肝损伤,包括酒精性肝炎、肝硬化和/或同时发展为肝细胞癌。肝实质的这些变化并不一定反映肝病进展的不同阶段,而是与组织学变化相关的连续性,可以在同一患者中同时观察到。事实上,只有35%的重度酗酒患者发展为晚期肝病,这表明在ALD的发病机制中,还涉及许多其他因素,包括性别、肥胖、饮酒模式、饮食因素、与性别无关的遗传因素和吸烟。此外,长期饮酒会对乙型或丙型肝炎和/或人类免疫缺陷病毒、非酒精性脂肪肝和血色素沉着症等肝脏疾病产生协同影响。ALD的诊断基于多种发现,包括大量饮酒史、伴随肝损伤的临床证据以及由此产生的组织学、影像学和实验室结果。根据各种严重程度的分级和预后系统,在脑病或预后不良的患者中观察到使用皮质类固醇治疗酒精性肝炎的有益效果,而在病情较轻的患者中,有害效果突出,因为与未使用皮质类固醇的患者相比,他们的感染风险增加。对于因各种原因不能服用皮质类固醇的酒精性肝炎患者和出现功能性肾功能衰竭(“肝肾综合征”)的患者,建议使用己酮可可碱。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Alcoholic Liver Disease from the Clinical Point of View
Liver disease is responsible for more than 55% of deaths resulting from alcohol abuse, while the prevalence of alcoholic liver disease (ALD) is closely correlated with per capita alcohol consumption. ALD represents a wide range of histological changes ranging from simple steatosis to heavier forms of liver injury including alcoholic hepatitis, cirrhosis and/or concurrent development of hepatocellular carcinoma. These alterations of the hepatic parenchyma do not necessarily reflect distinct stages of liver disease progression, but rather a continuum relating to histological changes that may be observed simultaneously in the same patient. The fact that only 35% of patients with heavy alcohol abuse develop advanced stages of liver disease, suggests that in the pathogenesis of ALD a number of other factors are involved that include gender, obesity, drinking patterns, dietary factors, non-sex-linked genetic factors and smoking. Also, long-term drinking can affect synergistically with hepatitis B or C and/or the human immunodeficiency virus, the non-alcoholic fatty liver disease and hepatic disorders such as hemochromatosis. The diagnosis of ALD is based on a combination of findings, including the history of significant alcohol consumption, the clinical evidence of the concomitant liver injury supported by the resultant histological, imaging and laboratory findings. A beneficial effect of alcoholic hepatitis treatment with corticosteroids is observed in patients with encephalopathy or with poor prognosis based on the various grading and prognostic systems of gravity, while the harmful effect is prominent in patients with milder disease, as they manifest an increased risk of infections compared with those not receiving corticosteroids. In patients with alcoholic hepatitis that cannot take corticosteroids for various reasons and in those with the onset of functional renal failure (“hepatorenal syndrome”), use of pentoxifylline is recommended.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
期刊最新文献
Efficacy of Infliximab after Failure of Subcutaneous Anti-TNF Agents in Patients with Moderate to Severe Ulcerative Colitis Hypocholesterolemia: a blessing or a problem? Physiotherapy in a Burn Patient Admitted in Intensive Care Unit Red Blood Cell Unit Utilization in the ICU: Evidence and Confidence Oncology News / Literature Review / July-December 2019
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1