Gelu-Simeon Moana, Mathurin Philippe
Service d'hépatogastro- entérologie, CHU de Guadeloupe, université des Antilles, Guadeloupe, France. Inserm, UMR-S 1085/IRSET, Rennes, France.
Service des maladies de l'appareil digestif, hôpital Claude- Huriez, université Lille-2, Inserm U795, Lille, France.
Rev Prat. 2018 Dec;68(10):1113-1118.
Alcoholic hepatitis. In a context of chronic alcoholic intoxication, the diagnosis of alcoholic hepatitis (AH) relies on a histological definition. When it is symptomatic, AH is a clinical syndrome associating jaundice, moderate fever, sensitivity of the right upper quadrant, loss of appetite and signs of hepatocellular insufficiency in severe forms. Typical biological tests show a moderate cytolysis with predominant AST, a high level of ãGT, and leukocytosis on neutrophils. Rising level of bilirubin and INR rates and low TP ratio are markers of severity of the disease. Regardless, the initial severity, abstinence has a decisive influence on long-term survival. In severe forms (Maddrey ≥ 32), corticosteroid for one month improves short-term survival, which response is evaluated by the Lille score. Accelerated procedure liver transplantation may be offered to some non-responders to medical treatment.
酒精性肝炎。在慢性酒精中毒的情况下，酒精性肝炎（AH）的诊断依赖于组织学定义。有症状时，AH是一种临床综合征，伴有黄疸、中度发热、右上腹压痛、食欲不振，严重时还伴有肝细胞功能不全的体征。典型的生物学检查显示有以AST为主的中度细胞溶解、γ-GT水平升高以及中性粒细胞增多。胆红素水平、国际标准化比值（INR）升高和总蛋白（TP）比值降低是疾病严重程度的指标。无论初始严重程度如何，戒酒对长期生存具有决定性影响。在严重形式（Maddrey评分≥32）中，使用皮质类固醇治疗一个月可提高短期生存率，其疗效通过里尔评分来评估。对于一些药物治疗无反应者，可考虑加速进行肝移植。
