Reep Gabriel L, Soloway Roger D
Gabriel L Reep, Department of Internal medicine, University of Texas Medical Branch, Galveston, TX 77555-0764, United States.
World J Hepatol. 2011 Aug 27;3(8):211-4. doi: 10.4254/wjh.v3.i8.211.
Patients with severe alcoholic hepatitis (AH) need to be treated with specific treatment for better outcome. Currently available specific treatment modalities are use of corticosteroids or pentoxifylline. However, the response rate to these drugs is only about 50%-60%. Hence, there is an urgent need for better and more effective treatment options. Tumor necrosis factor plays an important role in the pathogenesis of AH. However, agents blocking the action of tumor necrosis factor have not been found to be effective. Rather the randomized studies evaluating these agents showed an adverse effect and more infections in treated patients. Critical role of tumor necrosis factor in hepatic regeneration explaining this contrast is discussed. Oxidative stress and inflammation derived from gut bacteria ate two main components in the pathogenesis of AH laying foundation for the role of antioxidants, probiotics, and antibiotics in the management of AH. This article reviews the current data and status of these newer agents for the treatment of AH. Of the various options available, Vitamin E and N-acetylcysteine (NAC) have shown great promise for clinical use as adjunct to corticosteroids. With these encouraging data, future well designed studies are suggested to assess Vitamin E and NAC before their routine use in clinical practice in the management of AH.
重症酒精性肝炎（AH）患者需要接受特定治疗以获得更好的预后。目前可用的特定治疗方式是使用皮质类固醇或己酮可可碱。然而，这些药物的有效率仅约为50%-60%。因此，迫切需要更好、更有效的治疗选择。肿瘤坏死因子在AH的发病机制中起重要作用。然而，尚未发现阻断肿瘤坏死因子作用的药物有效。相反，评估这些药物的随机研究显示，治疗患者有不良反应且感染更多。本文讨论了肿瘤坏死因子在肝再生中的关键作用，解释了这种差异。肠道细菌产生的氧化应激和炎症是AH发病机制中的两个主要因素，为抗氧化剂、益生菌和抗生素在AH治疗中的作用奠定了基础。本文综述了这些治疗AH的新型药物的当前数据和现状。在各种可用选项中，维生素E和N-乙酰半胱氨酸（NAC）作为皮质类固醇的辅助药物在临床应用中显示出巨大潜力。基于这些令人鼓舞的数据，建议未来进行精心设计的研究，以在临床实践中常规使用维生素E和NAC治疗AH之前对其进行评估。
