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解决酒精相关性肝病临床未满足需求和挑战的研究方法。

Research methodologies to address clinical unmet needs and challenges in alcohol-associated liver disease.

机构信息

Department of Internal MedicineUniversity of South Dakota Sanford School of MedicineSioux FallsSouth DakotaUSA.

Division of Gastroenterology and HepatologyAvera Transplant InstituteSioux FallsSouth DakotaUSA.

出版信息

Hepatology. 2022 Apr;75(4):1026-1037. doi: 10.1002/hep.32143. Epub 2021 Nov 27.

Abstract

Alcohol-associated liver disease (ALD) is emerging worldwide as the leading cause of liver-related morbidity, mortality, and indication for liver transplantation. The ALD Special Interest Group and the Clinical Research Committee at the digital American Association for the Study of Liver Diseases meeting in November 2020 held the scientific sessions to identify clinical unmet needs in ALD, and addressing these needs using clinical research methodologies. Of several research methodologies, the sessions were focused on (a) studying disease burden of ALD using large administrative databases, (b) developing biomarkers for noninvasive diagnosis of alcohol-associated hepatitis (AH) and estimation of disease prognosis, (c) identifying therapeutic targets for ALD and AH, (d) deriving accurate models to predict prognosis or posttransplant alcohol relapse as a basis for developing treatment algorithm and a uniform protocol on patient-selection criteria for liver transplantation, and (e) examining qualitative research methodologies in studying the barriers to implementation of multidisciplinary integrated care model by hepatology and addiction teams for the management of dual pathology of liver disease and of alcohol use disorder. Prospective multicenter studies are required to address many of these clinical unmet needs. Further, multidisciplinary care models are needed to improve long-term outcomes in patients with ALD.

摘要

酒精相关性肝病(ALD)在全球范围内逐渐成为导致肝相关发病率、死亡率和肝移植指征的主要原因。在 2020 年 11 月举行的数字式美国肝病研究学会(AASLD)ALD 特别兴趣小组和临床研究委员会会议上,举行了科学会议,以确定 ALD 的未满足的临床需求,并使用临床研究方法来满足这些需求。在几种研究方法中,会议重点关注了:(a)使用大型行政数据库研究 ALD 的疾病负担;(b)开发用于非侵入性诊断酒精相关性肝炎(AH)和估计疾病预后的生物标志物;(c)确定 ALD 和 AH 的治疗靶点;(d)得出准确的模型来预测预后或移植后酒精复发,作为开发治疗算法和肝移植患者选择标准统一方案的基础;(e)研究定性研究方法,以了解肝病学和成瘾治疗团队实施多学科综合护理模式来管理肝脏疾病和酒精使用障碍双重病理的障碍。需要进行前瞻性多中心研究来解决这些临床需求中的许多问题。此外,还需要多学科的护理模式来改善 ALD 患者的长期预后。

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