Roldan Giovanni A, Tricarico Christopher, Brown Robert S
Department of Gastroenterology and Hepatology, Columbia University Irving Medical Center, Columbia University, New York, New York.
Department of Gastroenterology and Hepatology, University of Minnesota, Minneapolis, Minnesota.
Gastroenterol Hepatol (N Y). 2024 Nov;20(11):662-671.
Alcohol-associated liver disease (ALD) poses a significant global health burden and is a leading cause of liver-related morbidity and mortality. ALD encompasses a spectrum of disease states ranging from asymptomatic steatosis to acute hepatitis and cirrhosis. Alcohol use disorder (AUD) significantly increases the risk of developing ALD, and insight into AUD can provide a more complete understanding of ALD and the patients affected by these interrelated diseases. Accurate and timely identification of AUD, even in primary care, through validated screening tools combined with blood tests and imaging techniques facilitates early detection of ALD. Although liver transplantation (LT) remains the most effective treatment for end-stage ALD, patient outcomes post-LT have evolved because of shifting perspectives on ALD transplant eligibility, comprehensive pre-LT evaluations, and advancements in post-LT ALD detection. Nonetheless, addressing disparities in LT practices for ALD is paramount for ensuring equitable access to this life-saving intervention. This article offers an updated synopsis of ALD definitions, screening methodologies, and contemporary management approaches, particularly in the context of LT.
酒精性肝病（ALD）给全球健康带来了重大负担，是肝脏相关发病和死亡的主要原因。ALD涵盖了一系列疾病状态，从无症状脂肪变性到急性肝炎和肝硬化。酒精使用障碍（AUD）显著增加了患ALD的风险，深入了解AUD有助于更全面地理解ALD以及受这些相关疾病影响的患者。通过经过验证的筛查工具结合血液检测和成像技术，即使在初级保健中准确及时地识别AUD，也有助于早期发现ALD。尽管肝移植（LT）仍然是终末期ALD最有效的治疗方法，但由于对ALD移植资格的观念转变、全面的肝移植前评估以及肝移植后ALD检测的进展，肝移植后的患者结局有所改善。尽管如此，解决ALD肝移植实践中的差异对于确保公平获得这种挽救生命的干预措施至关重要。本文提供了ALD定义、筛查方法和当代管理方法的最新概述，特别是在肝移植的背景下。
