Guidelines of prevention and treatment for alcoholic liver disease:a 2018 update
-
摘要:
<正>酒精性肝病是由于长期大量饮酒导致的肝脏疾病。初期通常表现为脂肪肝,进而可发展成酒精性肝炎、肝纤维化和肝硬化。严重酗酒时可诱发广泛肝细胞坏死,甚至引起衰竭。酒精性肝病是我国常见的肝脏疾病之一,严重危害人民健康。为进一步规范酒精性肝病的诊断与治疗,中华医学会肝病学分会脂肪肝和酒精性肝病学组、中国医师协会脂肪性肝病专家委员会组织国内有关专家,在参考国内外最新研究成果和相关诊疗共识的基础上,对2010年制订的《酒精性
-
Key words:
- liver disease, alcoholic /
- diagnosis /
- therapy /
- practice guideline
-
[1]Cooperation Group of Alcohol Dependence and Liver Disease Investigation.Collaborative research on alcohol dependence among 4 occupational groups in 9 cities of China[J].Chin Mental Health J, 1992, 6 (3) :112-117, 136. (in Chinese) 酒依赖与肝病问题调查协作组.中国9个城市4种职业人群酒依赖协作研究 (一) (二) [J].中国心理卫生杂志, 1992, 6 (3) :112-117, 136 [2]CHEN SL, MENG XD, WANG BY, et al.An epidemiologic survey of alcoholic liver disease in some cities of Liaoning Province[J].J Pract Hepatol, 2010, 13 (6) :428-430, 435. (in Chinese) 陈士林, 孟晓丹, 王炳元, 等.辽宁省部分城市酒精性肝病流行现状调查[J].实用肝脏病杂志, 2010, 13 (6) :428-430, 435. [3]WANG H, MA L, YIN Q, et al.Prevalence of alcoholic liver diseaseand its association with socioeconomic status in North-Eastern China[J].Alcohol Clin Exp Res, 2014, 38 (4) :1035-1041. [4]HUANG SL, DAI SQ, ZHANG XH, et al.Epidemiological survey of alcoholic liver disease in Hunan[J].J Chin Physician, 2005, 7 (3) :426-427. (in Chinese) 黄顺玲, 戴水奇, 张雪红, 等.湖南省酒精性肝病流行病学调查概况[J].中国医师杂志, 2005, 7 (3) :426-427. [5]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. [6]LI YM, CHEN WX, YU CH, et al.An epidemiological survey of alcoholic liver disease in Zhejiang province[J].Chin J Hepatol, 2003, 11 (11) :647-649. (in Chinese) 厉有名, 陈卫星, 虞朝辉, 等.浙江省酒精性肝病流行病学调查概况[J].中华肝脏病杂志, 2003, 11 (11) :647-649. [7]ZHOU YJ, LI YY, NIE YQ, et al.Prevalence of fatty liver diseaseand its risk factors in the population of South China[J].World J Gastroenterol, 2007, 13 (47) :6419-6424. [8]YAO JH, ZHAO QD, XIONG PF, et al.Investigation of alcoholic liver disease in ethnic groups of Yuanjiang county in Yunnan[J].Chin J Gastroenterol Hepatol, 2011, 20 (12) :1137-1139. (in Chinese) 姚锦慧, 赵秋冬, 熊鹏芬, 等.云南元江少数民族酒精性肝病流行病学调查[J].胃肠病学和肝病学杂志, 2011, 20 (12) :1137-1139. [9]Cooperative Group of Alcoholic Liver Disease.Management of malignant biliary hilar obstruction with multiple stents[J].Chin J Dig, 2007, 27 (4) :231-234. (in Chinese) 全国酒精性肝病调查协作组.全国酒精性肝病的多中心调查分析[J].中华消化杂志, 2007, 27 (4) :231-234. [10]LIU Y, CHI BR.Clinical analysis of 237 cases of alcoholic cirrhosis[J].Jilin Med J, 2004, 25 (4) :40-42. (in Chinese) 刘阳, 迟宝荣.酒精性肝硬化237例临床分析[J].吉林医学, 2004, 25 (4) :40-42. [11]WANG H, WANG JB.Relationship between hepatitis virus infection and alcoholic cirrhosis (a report of 182 cases of alcoholic liver disease) [J].J Norman Bethune Univ (Med Sci) , 1998, 24 (6) :652-653. (in Chinese) 王辉, 王江滨.肝炎病毒感染与酒精性肝硬化关系的研究 (附182例酒精性肝病临床病例报告) [J].白求恩医科大学学报, 1998, 24 (6) :652-653. [12]WANG FS, FAN JG, ZHANG Z, et al.The global burden of liverdisease:the major impact of China[J].Hepatology, 2014, 60 (6) :2099-2108. [13]REHM J, TAYLOR B, MOHAPATRA S, et al.Alcohol as a risk factor forliver cirrhosis:a systematic review and meta-analysis[J].Drug AlcoholRev, 2010, 29 (4) :437-445. [14]SHEN Z, LI YM, YU CH, et al.Risk factors for alcohol-related liverinjury in the island population of China:a population-basedcase-control study[J].World J Gastroenterol, 2008, 14 (14) :2255-2261. [15]BECKER U, DEIS A, SORENSEN TI, et al.Prediction of risk of liverdisease by alcohol intake, sex, and age:a prospective populationstudy[J].Hepatology, 1996, 23 (5) :1025-1029. [16]CORRAO G, BAGNARDI V, ZAMBON A, et al.A meta-analysis ofalcohol consumption and the risk of 15 diseases[J].Prev Med, 2004, 38 (5) :613-619. [17]KAMPER-JORGENSEN M, GRONBAEK M, TOLSTRUP J, et al.Alcohol andcirrhosis:dose-response or threshold effect[J].J Hepatol, 2004, 41 (1) :25-30. [18]BECKER U, GRNBAEK M, JOHANSEN D, et al.Lower risk for alcohol-induced cirrhosis in wine drinkers[J].Hepatology, 2002, 35 (4) :868-875. [19]JIANG H, LIVINGSTON M, ROOM R, et al.Alcohol consumption andliver disease in Australia:a time series analysis of the period 1935-2006[J].Alcohol Alcohol, 2014, 49 (3) :363-368. [20]LU XL, LUO JY, TAO M, et al.Risk factors for alcoholic liverdisease in China[J].World J Gastroenterol, 2004, 10 (16) :2423-2426. [21]HATTON J, BURTON A, NASH H, et al.Drinking patterns, dependencyand life-time drinking history in alcohol-related liver disease[J].Addiction, 2009, 104 (4) :587-592. [22]SATO N, LINDROS KO, BARAONA E, et al.Sex difference in alcohol-related organ injury[J].Alcohol Clin Exp Res, 2001, 25 (S1) :40s-45s. [23]EAGON PK.Alcoholic liver injury:influence of gender and hormones[J].World J Gastroenterol, 2010, 16 (11) :1377-1384. [24]BARAONA E, ABITTAN CS, DOHMEN K, et al.Gender differences inpharmacokinetics of alcohol[J].Alcohol Clin Exp Res, 2001, 25 (4) :502-507. [25]WICKRAMASINGHE SN, CORRIDAN B, IZAGUIRRE J, et al.Ethnic differencesin the biological consequences of alcohol abuse:a comparisonbetween south Asian and European males[J].Alcohol Alcohol, 1995, 30 (5) :675-680. [26]BORRS E, COUTELLE C, ROSELL A, et al.Genetic polymorphism ofalcohol dehydrogenase in europeans:the ADH2*2 alleledecreases the risk for alcoholism and is associated with ADH3*1[J].Hepatology, 2000, 31 (4) :984-989. [27]YU C, LI Y, CHEN W, et al.Genotype of ethanol metabolizingenzyme genes by oligonucleotide microarray in alcoholic liverdisease in Chinese people[J].Chin Med J (Engl) , 2002, 115 (7) :1085-1087. [28]MENDENHALL C, ROSELLE GA, GARTSIDE P, et al.Relationship ofprotein calorie malnutrition to alcoholic liver disease:a reexaminationof data from two Veterans Administration Cooperative Studies[J].Alcohol Clin Exp Res, 1995, 19 (3) :635-641. [29]LEEVY CM, MOROIANU SA.Nutritional aspects of alcoholic liverdisease[J].Clin Liver Dis, 2005, 9 (1) :67-81. [30]MEZEY E.Dietary fat and alcoholic liver disease[J].Hepatology, 1998, 28 (4) :901-905. [31]WILLIAMS R.Global challenges in liver disease[J].Hepatology, 2006, 44 (3) :521-526. [32]Fatty Liver and Alcoholic Liver Disease Study Group of the Chinese Liver Disease Association.Guidelines for diagnosis and treatment of alcoholic liver diseases[J].Chin J Hepatol, 2006, 14 (3) :164-166. (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[J].中华肝脏病杂志, 2006, 14 (3) :164-166. [33]BUSH K, KIVLAHAN DR, MCDONELL MB, et al.The AUDIT alcoholconsumption questions (AUDIT-C) :an effective brief screeningtest for problem drinking.Ambulatory Care Quality Improvement Project (ACQUIP) .Alcohol Use Disorders Identification Test[J].Arch Intern Med, 1998, 158 (16) :1789-1795. [34]SODERSTROM CA, SMITH GS, KUFERA JA, et al.The accuracy of the CAGE, the Brief Michigan Alcoholism Screening Test, and the Alcohol Use Disorders Identification Test in screening traumacenter patients for alcoholism[J].J Trauma, 1997, 43 (6) :962-969. [35]CHEN CH, HUANG MH, YANG JC, et al.Prevalence and etiologyof elevated serum alanine aminotransferase level in an adultpopulation in Taiwan[J].J Gastroenterol Hepatol, 2007, 22 (9) :1482-1489. [36]CONIGRAVE KM, DEGENHARDT LJ, WHITFIELD JB, et al.CDT, GGT, and AST as markers of alcohol use:the WHO/ISBRA collaborativeproject[J].Alcohol Clin Exp Res, 2002, 26 (3) :332-339. [37]YERSIN B, NICOLET JF, DERCREY H, et al.Screening for excessive alcoholdrinking.Comparative value of carbohydrate-deficienttransferrin, gamma-glutamyltransferase, and mean corpuscular volume[J].Arch Intern Med, 1995, 155 (17) :1907-1911. [38]MAJHI S, BARAL N, LAMSAL M, et al.De Ritis ratio as diagnosticmarker of alcoholic liver disease[J].Nepal Med Coll J, 2006, 8 (1) :40-42. [39]NYBLOM H, BERGGREN U, BALLDIN J, et al.High AST/ALT ratiomay indicate advanced alcoholic liver disease rather thanheavy drinking[J].Alcohol Alcohol, 2004, 39 (4) :336-339. [40]BARDOU-JACQUET E, LEGROS L, SORO D, et al.Effect of alcohol consumptionon liver stiffness measured by transient elastography[J].World J Gastroenterol, 2013, 19 (4) :516-522. [41]BENSAMOUN SF, LECLERC GE, DEBERNARD L, et al.C utoff values foralcoholic liver fibrosis using magnetic resonance elastographytechnique[J].Alcohol Clin Exp Res, 2013, 37 (5) :811-817. [42]D'ASSIGNIES G, RUEL M, KHIAT A, et al.Noninvasive quantitation ofhuman liver steatosis using magnetic resonance and bioassaymethods[J].Eur Radiol, 2009, 19 (8) :2033-2040. [43]GRAIF M, YANUKA M, BARAZ M, et al.Quantitative estimation ofattenuation in ultrasound video images:correlation with histologyin diffuse liver disease[J].Invest Radiol, 2000, 35 (5) :319-324. [44]ATASEVEN H, YILDRIM MH, YALNIZ M, et al.Correlation betweencomputerized tomographic findings and histopathologic grade/stagein non-alcoholic steatohepatitis[J].J Hepatol, 2003, 38 (Suppl 2) :204. [45]FARRELL GC, GEORGE J, PAULINE de la M, et al.Fatty liver disease:NASH and related disorders[M].Oxford:Blsckwell Publishing, 2005:159-207. [46]MANCINI M, PRINSTER A, ANNUZZI G, et al.Sonographic hepatic-renal ratio as indicator of hepatic steatosis:comparison with (1) H magnetic resonance spectroscopy[J].Metabolism, 2009, 58 (12) :1724-1730. [47]NAHON P, KETTANEH A, TENGHER-BARNA I, et al.Assessment of liverfibrosis using transient elastography in patients with alcoholicliver disease[J].J Hepatol, 2008, 49 (6) :1062-1068. [48]SANYAL AJ, American Gastroenterological Association.AGA technicalreview on nonalcoholic fatty liver disease[J].Gastroenterology, 2002, 123 (5) :1705-1725. [49]SHEN F, FAN JG.Current status of transient elastography for assessing patients with fatty liver disease[J].Chin J Hepatol, 2014, 22 (9) :643-646. (in Chinese) 沈峰, 范建高.瞬时弹性成像技术在脂肪性肝病中的应用现状[J].中华肝脏病杂志, 2014, 22 (9) :643-646. [50]SHEN F, ZHENG RD, MI YQ, et al.A multi-center clinical study of a novel controlled attenuation parameter for assessment of fatty liver[J].Chin J Hepatol, 2014, 22 (12) :926-931. (in Chinese) 沈峰, 郑瑞丹, 宓余强, 等.受控衰减参数诊断脂肪肝的临界值初探:一项多中心临床研究[J].中华肝脏病杂志, 2014, 22 (12) :926-931. [51]Consensus expert committee on clinical application of transient elastography (TE) .Expert consensus on clinical application of transient elastography (TE) (2015) [J/CD].Chin J Liver Dis:Electronic Edition, 2015, 7 (2) :12-18. (in Chinese) 瞬时弹性成像技术 (TE) 临床应用共识专家委员会.瞬时弹性成像技术 (TE) 临床应用专家共识 (2015年) [J/CD].中国肝脏病杂志:电子版, 2015, 7 (2) :12-18. [52]SINGH S, FUJII LL, MURAD MH, et al.Liver stiffness is associatedwith risk of decompensation, liver cancer, and death in patientswith chronic liver diseases:a systematic review and meta-analysis[J].Clin Gastroenterol Hepatol, 2013, 11 (12) :1573-1584. [53]European Association for Study of Liver, Asociacion Latinoamericanapara el Estudio del Higado.EASL-ALEH Clinical Practice Guidelines:Non-invasive tests for evaluation of liver diseaseseverity and prognosis[J].J Hepatol, 2015, 63 (1) :237-264. [54]CASTERA L.Hepatitis B:are non-invasive markers of liver fibrosisreliable[J].Liver Int, 2014, 34 (Suppl 1) :91-96. [55]HUWART L, SEMPOUX C, VICAUT E, et al.Magnetic resonance elastographyfor the noninvasive staging of liver fibrosis[J].Gastroenterology, 2008, 135 (1) :32-40. [56]CARITHERS RL JR, HERLONG HF, DIEHL AM, et al.Methylprednisolonetherapy in patients with severe alcoholic hepatitis.A randomizedmulticenter trial[J].Ann Intern Med, 1989, 110 (9) :685-690. [57]DOMINGUEZ M, RINCN D, ABRALDES JG, et al.A new scoring systemfor prognostic stratification of patients with alcoholic hepatitis[J].Am J Gastroenterol, 2008, 103 (11) :2747-2756. [58]FORREST EH, EVANS CD, STEWART S, et al.Analysis of factors predictiveof mortality in alcoholic hepatitis and derivation andvalidation of the Glasgow alcoholic hepatitis score[J].Gut, 2005, 54 (8) :1174-1179. [59]LOUVET A, NAVEAU S, ABDELNOUR M, et al.The Lille model:anew tool for therapeutic strategy in patients with severe alcoholichepatitis treated with steroids[J].Hepatology, 2007, 45 (6) :1348-1354. [60]PAPASTERGIOU V, TSOCHATZIS EA, PIERI G, et al.Nine scoring modelsmodelsfor short-term mortality in alcoholic hepatitis:cross-validationin a biopsy-proven cohort[J].Aliment Pharmacol Ther, 2014, 39 (7) :721-732. [61]SAID A, WILLIAMS J, HOLDEN J, et al.Model for end stage liverdisease score predicts mortality across a broad spectrum of liverdisease[J].J Hepatol, 2004, 40 (6) :897-903. [62]SRIKUREJA W, KYULO NL, RUNYON BA, et al.MELD score is abetter prognostic model than Child-Turcotte-Pugh score or Discriminant Function score in patients with alcoholic hepatitis[J].J Hepatol, 2005, 42 (5) :700-706. [63]BARVE A, KHAN R, MARSANO L, et al.Treatment of alcoholic liverdisease[J].Ann Hepatol, 2008, 7 (1) :5-15. [64]European Association for the Study of Liver.EASL clinicalpractical guidelines:management of alcoholic liver disease[J].J Hepatol, 2012, 57 (2) :399-420. [65]TILG H, DAY CP.Management strategies in alcoholic liver disease[J].Nat Clin Pract Gastroenterol Hepatol, 2007, 4 (1) :24-34. [66]O'SHEA RS, DASARATHY S, MCCULLOUGH AJ, et al.Alcoholic liverdisease[J].Hepatology, 2010, 51 (1) :307-328. [67]DICECCO SR, FRANCISCO-ZILLER N.Nutrition in alcoholic liver disease[J].Nutr Clin Pract, 2006, 21 (3) :245-254. [68]Mc CLAIN CJ, BARVE SS, BARVE A, et al.Alcoholic liver diseaseand malnutrition[J].Alcohol Clin Exp Res, 2011, 35 (5) :815-820. [69]STICKEL F, HOEHN B, SCHUPPAN D, et al.Review article:Nutritionaltherapy in alcoholic liver disease[J].Aliment Pharmacol Ther, 2003, 18 (4) :357-373. [70]MATHURIN P, O'GRADY J, CARITHERS RL, et al.Corticosteroids improveshort-term survival in patients with severe alcoholic hepatitis:meta-analysis of individual patient data[J].Gut, 2011, 60 (2) :255-260. [71]THURSZ MR, RICHARDSON P, ALLISON M, et al.Prednisolone or pentoxifyllinefor alcoholic hepatitis[J].N Engl J Med, 2015, 372 (17) :1619-1628. [72]GUERRINI I, GENTILI C, NELLI G, et al.A follow up study on theefficacy of metadoxine in the treatment of alcohol dependence[J].Subst Abuse Treat Prev Policy, 2006, 1:35. [73]LEGGIO L, KENNA GA, FERRULLII A, et al.Preliminary findings on theuse of metadoxine for the treatment of alcohol dependence andalcoholic liver disease[J].Hum Psychopharmacol, 2011, 26 (8) :554-559. [74]SHPILENYA LS, MUZYCHENKO AP, GASBARRINI G, et al.Metadoxine inacute alcohol intoxication:a double-blind, randomized, placebocontrolledstudy[J].Alcohol Clin Exp Res, 2002, 26 (3) :340-346. [75]HIGUERA-de la TIJERA F, SERVN-CAAMAO AI, SERRALDE-ZU'IGA AE, et al.Metadoxine improves the three-and six-monthsurvival rates in patients with severe alcoholic hepatitis[J].World J Gastroenterol, 2015, 21 (16) :4975-4985. [76] MAO YM, ZENG MD, LU LG, et al.Capsule metadoxine in the treatment of alcoholic liver disease:A randomized, double-blind, placebo-controlled, multicenter study[J].Chin J Hepatol, 2009, 17 (3) :213-216. (in Chinese) 茅益民, 曾民德, 陆伦根, 等.美他多辛治疗酒精性肝病的多中心、随机、双盲、安慰剂平行对照的临床研究[J].中华肝脏病杂志, 2009, 17 (3) :213-216. [77]MATO JM, CMARA J, FERNNDEZ de PAZ J, et al.S-adenosylmethioninein alcoholic liver cirrhosis:a randomized, placebocontrolled, double-blind, multicenter clinical trial[J].J Hepatol, 1999, 30 (6) :1081-1089. [78]BAI B, HE Q, TANG W, et al.S-adenosyl methionine treatment for alcoholic liver disease:a systematic review[J/CD].Chin J Liver Dis:Electronic Edition, 2012, 4 (2) :1-9. (in Chinese) 白冰, 何清, 唐尉, 等.S-腺苷蛋氨酸治疗酒精性肝病的系统评价[J/CD].中国肝脏病杂志:电子版, 2012, 4 (2) :1-9. [79]XING QT, YUAN MB, GAO XM.Observation of the effect of Sadenosyl-L-methionine on alcoholic liver disease[J].Chin J Gastroenterol Hepatol, 2002, 11 (3) :239-240, 242. (in Chinese) 邢全台, 袁孟彪, 高新民.思美泰治疗酒精性肝病疗效观察[J].胃肠病学和肝病学杂志, 2002, 11 (3) :239-240, 242. [80]MEDINA J, MORENO-OTERO R.Pathophysiological basis for antioxidanttherapy in chronic liver disease[J].Drugs, 2005, 65 (17) :2445-2461. [81]HU GP, LIU K, ZHAO LS.Polyunsaturated phosphatidylcholine (Essentiale) for alcoholic/fatty liver:a systematic review[J].Chin Hepatol, 2005, 10 (1) :5-7. (in Chinese) 胡国平, 刘凯, 赵连三.多烯磷脂酰胆碱 (易善复) 治疗酒精性肝病和脂肪肝的系统评价[J].肝脏, 2005, 10 (1) :5-7. [82]FANG LH, ZHANG H.The observation of reduced glutathione combined with legalon curative effect in the treatment of alcoholic hepatitis[J].Chin Hepatol, 2004, 9 (3) :181-182. (in Chinese) 方丽华, 张虹.还原型谷胱甘肽联合利加隆治疗酒精性肝炎疗效观察[J].肝脏, 2004, 9 (3) :181-182. [83]LI LJ, LI W.Glutathione in the treatment of alcoholic liver disease:a clinical observation of 35 cases[J].J Pract Hepatol, 2007, 10 (5) :329-330. (in Chinese) 李丽军, 李卫.还原型谷胱甘肽治疗酒精性肝病35例临床观察[J].实用肝脏病杂志, 2007, 10 (5) :329-330. [84]ZHANG QH, GUO SH, HU DR, et al.Effect of domestic glutathione on the alcoholic liver disease[J].Chin J Hepatol, 2000, 8 (4) :239-240. (in Chinese) 张全海, 郭树华, 胡大荣, 等.国产还原型谷胱甘肽治疗酒精性肝病疗效观察[J].中华肝脏病杂志, 2000, 8 (4) :239-240. [85]MA AL, GUO XZ, LIU X, et al.Efficacy comparison between bicyclol and polyene phosphatidylcholine treatments for alcoholic liver disease[J].Chin J Hepatol, 2011, 19 (6) :471-472. (in Chinese) 马安林, 郭新珍, 刘霞, 等.双环醇与多烯磷脂酰胆碱治疗酒精性肝病的疗效比较[J].中华肝脏病杂志, 2011, 19 (6) :471-472. [86]MA AL, LIU SE, LIU X, et al.Comparison of liver histology with alcoholic liver disease after treating with bicyclol and polyene phosphatidylcholine[J].J Clin Hepatol, 2006, 22 (4) :272-275. (in Chinese) 马安林, 刘淑娥, 刘霞, 等.双环醇与多烯磷脂酰胆碱治疗酒精性脂肪肝的临床病理比较[J].临床肝胆病杂志, 2006, 22 (4) :272-275. [87]MATHURIN P, MORENO C, SAMUEL D, et al.Early liver transplantationfor severe alcoholic hepatitis[J].N Engl J Med, 2011, 365 (19) :1790-1800. [88]MURRAY KF, CARITHERS RL Jr, AASLD.AASLD practice guidelines:evaluation of the patient for liver transplantation[J].Hepatology, 2005, 41 (6) :1407-1432.
计量
- 文章访问数: 1313
- HTML全文浏览量: 80
- PDF下载量: 2004
- 被引次数: 0