Division of Gastroenterology and Hepatology, Medical Department, Clinic University Hospital of Valencia, Valencia, Spain.
Center for Liver Diseases, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Clin Mol Hepatol. 2023 Jan;29(1):1-15. doi: 10.3350/cmh.2022.0017. Epub 2022 Apr 15.
Alcohol-related liver disease (ALD) consists of a wide spectrum of clinical manifestations and pathological features, ranging from asymptomatic patients to decompensated cirrhosis and hepatocellular carcinoma. Patients with heavy alcohol intake and advanced fibrosis often develop a subacute form of liver failure called alcohol-induced hepatitis (AH). Globally, most patients with ALD are identified at late stages of the disease, limiting therapeutic interventions. Thus, there is a need for early detection of ALD patients, which is lacking in most countries. The identification of alcohol misuse is hampered by the existence of alcohol underreporting by many patients. There are useful biomarkers that can detect recent alcohol use. Moreover, there are several non-invasive techniques to assess the presence of advanced fibrosis among patients with alcohol misuse, which could identify patients at high risk of liver related events or early death. In this review, we discuss differences between early stages of ALD and AH as the cornerstone of advanced forms. A global overview of epidemiological, anthropometric, clinical, analytical, histological, and molecular differences is summarized in this article. We propose that campaigns aimed at identifying patients with subclinical forms can prevent the development of life-threatening forms.
酒精性肝病（ALD）的临床表现和病理特征广泛，从无症状患者到失代偿性肝硬化和肝细胞癌不等。大量饮酒且存在纤维化的患者常发生一种称为酒精性肝炎（AH）的亚急性肝衰竭。在全球范围内，大多数 ALD 患者在疾病晚期才被确诊，限制了治疗干预的时机。因此，大多数国家都需要早期发现 ALD 患者，但目前还做不到这一点。由于许多患者存在酒精漏报，因此很难确定酒精滥用情况。有一些有用的生物标志物可用于检测近期的饮酒情况。此外，还有一些非侵入性技术可用于评估酒精滥用患者是否存在晚期纤维化，这有助于确定发生肝脏相关事件或早期死亡风险较高的患者。在这篇综述中，我们讨论了 ALD 和 AH 的早期阶段之间的差异，这些差异是晚期疾病的基础。本文总结了酒精性肝病在全球范围内的流行病学、人体测量学、临床、分析、组织学和分子差异。我们认为，旨在识别亚临床患者的活动可以预防危及生命的疾病的发生。
