a Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Hanau, Academic Teaching Hospital of the Medical Faculty , Goethe University Frankfurt/Main , Frankfurt/Main , Germany.
Expert Opin Pharmacother. 2018 Jun;19(8):779-793. doi: 10.1080/14656566.2018.1465929. Epub 2018 Apr 30.
Clinicians caring for patients with alcoholic hepatitis (AH) are often confronted with the question of the best pharmacotherapy to be used.
This article covers metabolic aspects of alcohol as the basis of understanding pharmacotherapy and to facilitate choosing the drug therapeutic options for patients with severe AH.
Alcoholic steatohepatitis (ASH) and alcoholic hepatitis (AH) as terms are often used interchangeably in scientific literature but a stringent differentiation is recommended for proper clarity. As opposed to ASH, the clinical course of AH is often severe and requires an effective drug treatment strategy, in addition to absolute alcohol abstinence and nutritional support. Drug options include corticosteroids as a first choice and pentoxifylline, an inhibitor of phosphodiesterase, as a second line therapy, especially in patients with contraindications for a corticosteroid therapy such as infections or sepsis. At seven days under corticosteroids, treatment should be terminated in non-responders, and patients must then be evaluated for liver transplantation. Pentoxifylline is not effective as a rescue therapy for these patients. Other treatments such as infliximab, propylthiouracil, N-acetylcysteine, silymarin, colchicine, insulin and glucagon, oxandrolone, testosterone, and polyunsaturated lecithin are not effective in severe AH. For liver transplantation, few patients will be eligible.
治疗酒精性肝炎（AH）患者的临床医生经常面临选择最佳药物治疗的问题。
本文涵盖了酒精的代谢方面，作为理解药物治疗的基础，并为重症 AH 患者选择药物治疗方案提供便利。
酒精性脂肪性肝炎（ASH）和酒精性肝炎（AH）这两个术语在科学文献中经常互换使用，但为了准确起见，建议严格区分。与 ASH 不同，AH 的临床病程通常较为严重，除了绝对戒酒和营养支持外，还需要有效的药物治疗策略。药物选择包括皮质类固醇作为首选，以及磷酸二酯酶抑制剂己酮可可碱作为二线治疗，特别是在皮质类固醇治疗有禁忌症（如感染或败血症）的患者中。如果在皮质类固醇治疗七天后没有应答，应终止治疗，此时必须评估患者是否适合进行肝移植。对于这些患者，己酮可可碱无效作为抢救治疗。其他治疗方法，如英夫利昔单抗、丙硫氧嘧啶、N-乙酰半胱氨酸、水飞蓟素、秋水仙碱、胰岛素和胰高血糖素、氧雄龙、睾酮和多不饱和卵磷脂，对重症 AH 均无效。对于肝移植，只有少数患者符合条件。
