关键词： AC, Amoxicillin/clavulanate ACLF, Acute-on-Chronic Liver Failure ADLs, Activities of Daily Living AH, Alcohol-Associated Hepatitis AKI-HRS, Acute Kidney Injury - Hepatorenal Syndrome ALD ALD, Alcohol-Associated Liver Disease ASH, Alcoholic Steatohepatitis AUD, Alcohol Use Disorder AWS, Alcohol Withdrawal Syndrome BCAAs, Branched-Chain Amino Acids CDC, Center for Disease Control CI, Confidence Interval COVID-19, Coronavirus Disease 2019 CT, Computerized Tomography GABA, gamma-aminobutyric acid agonist HBV, Hepatitis B Virus HCC, Hepatocellular Carcinoma HCV, Hepatitis C Virus HE, Hepatic Encephalopathy HIV, Human Immunodeficiency Virus HR, Hazard Ratio IBW, Ideal Body Weight ICA, International Club of Ascites IL-1β, Interleukin-1β IL-22, Interleukin-22 KPS, Karnofsky Performance Status LB, Liver Biopsy LPS, Lipopolysaccharide LSM, Liver Stiffness Measurement LT, Liver Transplantation MDF, Maddrey’s Discriminant Function MELD, Model of End-Stage Liver Disease MRI, Magnetic Resonance Imaging MUST, Malnutrition Universal Screening Tool NIAAA, National Institute on Alcohol Abuse and Alcoholism NRS-2002, Nutritional Risk Screening-2002 OR, Odds Ratio PAMPs, Pathogen-Activated Molecular Patterns PMI, Psoas Muscle Index PTX, Pentoxifylline RAI, Relative Adrenal Insufficiency RCT, Randomized Clinical Trials RFH-NPT, Royal Free Hospital-Nutritional Prioritizing Tool ROS, Reactive Oxygen Species RR, Relative Risk SIRS, Systemic Inflammatory Response Syndrome TNF, Tumor Necrosis Factor WKS, Wernicke-Korsakoff Syndrome alcohol alcohol use disorders alcohol-associated hepatitis cirrhosis fatty liver disease steatosis

来  源：   DOI：10.1016/j.jceh.2022.02.001   PDF(Pubmed)

Abstract：
Alcohol-associated liver disease is one of the main causes of chronic liver disease. It comprises a clinical-histologic spectrum of presentations, from steatosis, steatohepatitis, to different degrees of fibrosis, including cirrhosis and severe necroinflammatory disease, called alcohol-associated hepatitis. In this focused update, we aim to present specific therapeutic interventions and strategies for the management of alcohol-associated liver disease. Current evidence for management in all spectra of manifestations is derived from general chronic liver disease recommendations, but with a higher emphasis on abstinence and nutritional support. Abstinence should comprise the treatment of alcohol use disorder as well as withdrawal syndrome. Nutritional assessment should also consider the presence of sarcopenia and its clinical manifestation, frailty. The degree of compensation of the disease should be evaluated, and complications, actively sought. The most severe acute form of this disease is alcohol-associated hepatitis, which has high mortality and morbidity. Current treatment is based on corticosteroids that act by reducing immune activation and blocking cytotoxicity and inflammation pathways. Other aspects of treatment include preventing and treating hepatorenal syndrome as well as preventing infections although there is no clear evidence as to the benefit of probiotics and antibiotics in prophylaxis. Novel therapies for alcohol-associated hepatitis include metadoxine, interleukin-22 analogs, and interleukin-1-beta antagonists. Finally, granulocyte colony-stimulating factor, microbiota transplantation, and gut-liver axis modulation have shown promising results. We also discuss palliative care in advanced alcohol-associated liver disease.
摘要：
酒精相关性肝病是慢性肝病的主要病因之一。它包括临床组织学表现，从脂肪变性，脂肪性肝炎,不同程度的纤维化，包括肝硬化和严重的坏死性炎,称为酒精相关性肝炎。在这个重点更新中，我们的目标是提出治疗酒精相关性肝病的具体干预措施和策略.目前所有症状的治疗证据来自一般慢性肝病的建议，但更强调禁欲和营养支持。禁欲应包括治疗酒精使用障碍以及戒断综合征。营养评估还应考虑肌少症的存在及其临床表现，脆弱。应评估疾病的补偿程度，和并发症，积极寻求。这种疾病最严重的急性形式是酒精相关性肝炎，有很高的死亡率和发病率。目前的治疗基于皮质类固醇，其通过减少免疫激活并阻断细胞毒性和炎症途径起作用。治疗的其他方面包括预防和治疗肝肾综合征以及预防感染，尽管没有明确的证据表明益生菌和抗生素在预防中的益处。酒精相关性肝炎的新疗法包括美他多辛，白细胞介素-22类似物，和白细胞介素-1-β拮抗剂.最后,粒细胞集落刺激因子，微生物移植，和肠-肝轴调制已显示出有希望的结果。我们还讨论了晚期酒精相关肝病的姑息治疗。
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