Ceccanti Mauro, Attili Adolfo, Balducci Giuseppe, Attilia Fabio, Giacomelli Stefano, Rotondo Claudia, Sasso Guido Francesco, Xirouchakis Elias, Attilia Maria Luisa
Alcohol Liver Disease Unit, University "La Sapienza", Roma, Italy.
J Clin Gastroenterol. 2006 Oct;40(9):833-41. doi: 10.1097/01.mcg.0000225570.04773.5d.
Acute alcoholic hepatitis (AAH) is a frequent inflammatory liver disease with high short-term mortality rate. In this review, relationships between alcohol abuse and the epidemiology and the outcomes of AAH are discussed, as well as AAH pathogenesis. The role of endotoxins, tumor necrosis factor alpha, fibroblasts, and immune response to altered hepatocyte proteins is discussed. The need of a careful prognosis, supported by the use of Maddrey score, by the model for end-stage liver disease [Mayo end-stage liver disease (MELD)] score or by the Glasgow alcoholic hepatitis score, is outlined, as the use of the most effective drugs (glucocorticoids and anti-tumor necrosis factor alpha infliximab) is recommended only in severe AAH cases. The problems of liver transplant in severe AAH, and the need of a 6-month alcohol abstinence before transplant, are discussed, as well as the need of a careful psychologic assessment before the transplant.
急性酒精性肝炎（AAH）是一种常见的炎症性肝病，短期死亡率很高。在本综述中，讨论了酒精滥用与AAH的流行病学及预后之间的关系，以及AAH的发病机制。还讨论了内毒素、肿瘤坏死因子α、成纤维细胞的作用以及对改变的肝细胞蛋白的免疫反应。概述了通过使用马德雷评分、终末期肝病模型[梅奥终末期肝病（MELD）]评分或格拉斯哥酒精性肝炎评分来进行仔细预后评估的必要性，因为仅在严重AAH病例中推荐使用最有效的药物（糖皮质激素和抗肿瘤坏死因子α英夫利昔单抗）。讨论了严重AAH患者肝移植的问题，以及移植前需戒酒6个月的必要性，还讨论了移植前进行仔细心理评估的必要性。
