Wiles Alan, Woodward Jeremy M
Department of Gastroenterology and Clinical Nutrition, Addenbrookes Hospital, Cambridge, UK.
Curr Opin Clin Nutr Metab Care. 2009 May;12(3):265-72. doi: 10.1097/MCO.0b013e328329e4ef.
To summarize the current management of intestinal failure-associated liver disease (IFALD) by reviewing recent advances in our understanding of the condition and the effects of different therapeutic approaches.
The importance of gastrointestinal length and continuity in the aetiology and treatment of IFALD has been demonstrated in both retrospective and interventional cohorts. A mechanism for the cholestatic effect of soy-based lipid has been described, and the clinical use of alternative lipid sources has demonstrated benefit. Prevention of IFALD has been shown with the use of erythromycin in neonates, and reversal of established IFALD has been demonstrated with isolated intestinal transplantation.
A greater understanding of the mechanisms of IFALD has led to promising interventions to prevent and treat the condition. Other possible therapeutic targets require more formal evaluation, and further work is required to develop noninvasive tools for the assessment and prognosis of IFALD that will guide treatment and help in the selection of patients and timing of transplantation.
通过回顾我们对肠衰竭相关肝病（IFALD）的最新认识进展以及不同治疗方法的效果，总结IFALD的当前管理方法。
胃肠道长度和连续性在IFALD病因及治疗中的重要性已在回顾性和干预性队列研究中得到证实。已描述了大豆基脂质产生胆汁淤积作用的机制，替代脂质来源的临床应用已显示出益处。在新生儿中使用红霉素已证明可预防IFALD，而孤立性肠移植已证明可逆转已发生的IFALD。
对IFALD机制的更深入了解已带来了有前景的预防和治疗该疾病的干预措施。其他可能的治疗靶点需要更正式的评估，并且需要进一步开展工作以开发用于IFALD评估和预后的非侵入性工具，从而指导治疗并有助于患者选择和移植时机的确定。
