Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang 110001, China.
Hepatobiliary Pancreat Dis Int. 2011 Oct;10(5):458-64. doi: 10.1016/s1499-3872(11)60079-9.
Alcoholic hepatitis (AH) is a necrotizing inflammatory process caused by alcoholic liver injury. It carries a significant short-term mortality. The management of AH is challenging. Although corticosteroids have been demonstrated to exert anti-inflammatory and antifibrotic effects, their efficacy for the treatment of AH remains debatable.
A literature search was performed of MEDLINE, ScienceDirect, SpringerLink and Wiley InterScience using the keywords "alcoholic hepatitis", "alcoholic liver disease", and "corticosteroids". The available data reported in the relevant literature were analyzed.
More than 17 controlled trials and at least 13 meta-analyses have reported the efficacy of corticosteroids in the treatment of AH in the past 40 years. Many were poorly designed and used different inclusion/exclusion criteria, making it difficult to reach a consensus. In this review, we summarized all the controversial data in the past decade and analyzed the potential causes for the varying therapeutic effects of corticosteroids in AH. The focus of the controversy has changed from "whether steroids are beneficial or harmful for AH patients" to "how to accurately identify responders to steroids early and rationalize corticosteroid treatment". An early response to glucocorticoids, as determined by calculating the Lille score after 7 days of treatment, has been shown to be a clinically useful indicator. Moreover, down-regulation of steroid sensitivity, risk of infection, and a rational therapeutic strategy of corticosteroids in AH patients are all crucial for therapeutic effect.
An early and accurate determination of steroid sensitivity is important. Besides, we need to overcome the down-regulation of steroid sensitivity, reduce the infection risk and rationalize the therapeutic strategy of corticosteroids. A fresh perspective is needed on the use of corticosteroids in AH patients.
酒精性肝炎（AH）是由酒精性肝损伤引起的坏死性炎症过程。它具有显著的短期死亡率。AH 的治疗具有挑战性。尽管皮质类固醇已被证明具有抗炎和抗纤维化作用，但它们在治疗 AH 中的疗效仍存在争议。
使用“酒精性肝炎”、“酒精性肝病”和“皮质类固醇”等关键词，对 MEDLINE、ScienceDirect、SpringerLink 和 Wiley InterScience 进行了文献检索。分析了相关文献中报告的现有数据。
在过去的 40 年中，超过 17 项对照试验和至少 13 项荟萃分析报告了皮质类固醇治疗 AH 的疗效。许多设计较差，使用不同的纳入/排除标准，难以达成共识。在本综述中，我们总结了过去十年中所有有争议的数据，并分析了皮质类固醇在 AH 中治疗效果不同的潜在原因。争议的焦点已经从“皮质类固醇对 AH 患者是有益还是有害”转变为“如何准确识别早期对皮质类固醇有反应的患者并合理化皮质类固醇治疗”。治疗后 7 天计算 Lille 评分，对糖皮质激素的早期反应已被证明是一种有用的临床指标。此外，下调类固醇敏感性、感染风险以及 AH 患者皮质类固醇的合理治疗策略对治疗效果至关重要。
早期准确确定类固醇敏感性很重要。此外，我们需要克服类固醇敏感性下降、降低感染风险并合理优化皮质类固醇的治疗策略。需要对 AH 患者使用皮质类固醇有新的认识。
