Hazeldine Simon, Hydes Theresa, Sheron Nick
Fiona Stanley Hospital, Murdoch, Australia;
Faculty of Medicine, University of Southampton, Southampton, UK;
Clin Med (Lond). 2015 Apr;15(2):179-85. doi: 10.7861/clinmedicine.15-2-179.
It takes upwards of ten years for alcohol-related liver disease to progress from fatty liver through fibrosis to cirrhosis to acute on chronic liver failure. This process is silent and symptom free and can easily be missed in primary care, usually presenting with advanced cirrhosis. At this late stage, management consists of expert supportive care, with prompt identification and treatment of bleeding, sepsis and renal problems, as well as support to change behaviour and stop harmful alcohol consumption. There are opportunities to improve care by bringing liver care everywhere up to the standards of the best liver units, as detailed in the Lancet Commission report. We also need a fundamental rethink of the technologies and approaches used in primary care to detect and intervene in liver disease at a much earlier stage. However, the most effective and cost-effective measure would be a proper evidence-based alcohol strategy.
酒精性肝病从脂肪肝发展到纤维化、再到肝硬化，直至慢性肝病急性肝衰竭，病程长达十年以上。这个过程悄无声息，没有症状，在初级医疗保健中很容易被忽视，通常在出现晚期肝硬化时才被发现。在这个晚期阶段，治疗包括专家支持性护理，及时识别和治疗出血、败血症及肾脏问题，同时提供支持以改变行为并停止有害饮酒。正如《柳叶刀》委员会报告中所详述的，通过将各地的肝脏护理提升至最佳肝脏治疗单位的标准，存在改善护理的机会。我们还需要从根本上重新思考初级医疗保健中用于在更早阶段检测和干预肝病的技术和方法。然而，最有效且最具成本效益的措施将是一项基于充分证据的酒精战略。
