Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
Department of Brain Sciences, Imperial College London, London, UK.
BMJ. 2023 Nov 20;383:e077090. doi: 10.1136/bmj-2023-077090.
Alcohol-related liver disease (ALD) is a major cause of liver-related morbidity and mortality. Epidemiological trends indicate recent and predicted increases in the burden of disease. Disease progression is driven by continued alcohol exposure on a background of genetic predisposition together with environmental cofactors. Most individuals present with advanced disease despite a long history of excessive alcohol consumption and multiple missed opportunities to intervene. Increasing evidence supports the use of non-invasive tests to screen for and identify disease at earlier stages. There is a definite role for public health measures to reduce the overall burden of disease. At an individual level, however, the ability to influence subsequent disease course by modifying alcohol consumption or the underlying pathogenic mechanisms remains limited due to a comparative lack of effective, disease-modifying medical interventions. Abstinence from alcohol is the key determinant of outcome in established ALD and the cornerstone of clinical management. In those with decompensated ALD, liver transplant has a clear role. There is consensus that abstinence from alcohol for an arbitrary period should not be the sole determinant in a decision to transplant. An increasing understanding of the mechanisms by which alcohol causes liver disease in susceptible individuals offers the prospect of new therapeutic targets for disease-modifying drugs. Successful translation will require significant public and private investment in a disease area which has traditionally been underfunded when compared to its overall prevalence.
酒精性肝病 (ALD) 是导致肝相关发病率和死亡率的主要原因。流行病学趋势表明，疾病负担近期有所增加，并预计未来还会进一步增加。疾病的进展是由持续的酒精暴露在遗传易感性的背景下以及环境共同因素驱动的。尽管大多数人有长期过量饮酒史，且多次错失干预机会，但他们仍处于晚期疾病阶段。越来越多的证据支持使用非侵入性测试在早期阶段筛查和识别疾病。采取公共卫生措施来减轻整体疾病负担是明确的。然而，由于缺乏有效的、能改变疾病进程的医学干预措施，个人通过改变饮酒量或潜在的致病机制来影响后续疾病进程的能力仍然有限。在已确诊的 ALD 中，戒酒是决定预后的关键因素，也是临床管理的基石。对于失代偿性 ALD 患者，肝移植有明确的作用。人们已经达成共识，即戒酒的时间不应是决定是否进行移植的唯一因素。对酒精在易患个体中导致肝病的机制的深入了解，为开发能改变疾病进程的药物提供了新的治疗靶点。要想成功转化，就需要在这个一直以来都资金投入不足的疾病领域投入大量的公共和私人资金，与该疾病的总体流行程度相比，这是远远不够的。
