Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242-1081, USA,
Dig Dis Sci. 2014 Oct;59(10):2357-66. doi: 10.1007/s10620-014-3173-8. Epub 2014 May 6.
Alcoholic hepatitis is an acute manifestation of alcoholic liver disease with mortality as high as 40-50% in severe cases. Patients usually have a history of prolonged alcohol abuse with or without a known history of liver disease. Although there is significant range in severity at presentation, patients with severe alcoholic hepatitis typically present with anorexia, fatigue, fever, jaundice, and ascites. The use of either pentoxifylline or corticosteroids in those with severe disease (Maddrey's discriminate function >32) has significant mortality benefit. The addition of N-acetylcysteine to corticosteroids decreases the incidences of hepatorenal syndrome, infection, and short-term mortality, but does not appear to significantly affect 6-month mortality. Nutritional support with high-calorie, high-protein diet is recommended in all patients screening positive for malnutrition. Liver transplantation for a highly selected group of patients with severe alcoholic hepatitis may be an option in the future, but is not currently recommended or available at most transplant institutions.
酒精性肝炎是一种急性的酒精性肝病表现，重症患者的死亡率高达 40-50%。患者通常有长期酗酒史，且可能伴有或不伴有已知的肝病病史。尽管在就诊时严重程度的范围差异很大，但重症酒精性肝炎患者通常表现为食欲不振、乏力、发热、黄疸和腹水。对于病情严重的患者（Maddrey 判别函数>32），使用己酮可可碱或皮质类固醇治疗具有显著的生存获益。在皮质类固醇中添加 N-乙酰半胱氨酸可降低肝肾综合征、感染和短期死亡率的发生率，但似乎不会显著影响 6 个月的死亡率。对于所有营养不良筛查阳性的患者，建议给予高热量、高蛋白饮食的营养支持。对于一组经过严格选择的重症酒精性肝炎患者，肝移植可能是一种选择，但目前在大多数移植机构不推荐或不可用。
