Michel H, Larrey D, Blanc P
Service d'Hépato-gastroentérologie, Institut des Maladies de l'Appareil Digestit, Hôpital Saint-Eloi, Montpellier.
Ann Gastroenterol Hepatol (Paris). 1993 Jan-Feb;29(1):29-39.
Acute alcoholic hepatitis is the first alcoholic lesion of the liver in the process of progression to cirrhosis. It is due to the toxic action of alcohol on hepatocytes, in particular in the centrolobular region. It may affect a liver which is the site of fatty infiltration, fibrosis or cirrhosis, i.e. during all the stages of alcoholic liver disease. Its severity depends upon the degree of alcoholic intoxication. It may be fatal by malignant hepatic failure in a quarter of cases or, at the extreme, be totally asymptomatic. The aims of treatment are: 1) in the immediate, to prevent death; 2) subsequently, to prevent progression to cirrhosis. The majority of the wide range of treatments suggested have been evaluated in controlled trials. It is thus easy to show that corticosteroids are effective in severe acute alcoholic hepatitis, i.e. with encephalopathy and coagulation disturbances, but no in ordinary forms. Although logical, nutritional supplements, whether enteral or parenteral, have no influence on the course of acute alcoholic hepatitis. The same applies to anabolic steroids, the association insulin-glucagon, antifibrosis agents or "hepatoprotectors". The elimination of alcoholic intoxication remains the most important point, accepted by all hepatologists.
急性酒精性肝炎是肝脏在发展为肝硬化过程中首个出现的酒精性病变。它是由于酒精对肝细胞，尤其是肝小叶中心区域的肝细胞产生毒性作用所致。它可发生于存在脂肪浸润、纤维化或肝硬化的肝脏，即在酒精性肝病的所有阶段。其严重程度取决于酒精中毒的程度。四分之一的病例可能因恶性肝衰竭而致命，或者在极端情况下完全没有症状。治疗的目标是：1）立即防止死亡；2）随后防止进展为肝硬化。大多数提出的广泛治疗方法已在对照试验中进行了评估。因此很容易表明，皮质类固醇对严重急性酒精性肝炎有效，即伴有脑病和凝血障碍的情况，但对普通形式无效。尽管合理，但肠内或肠外营养补充剂对急性酒精性肝炎的病程没有影响。合成代谢类固醇、胰岛素 - 胰高血糖素联合用药、抗纤维化药物或“肝保护剂”也是如此。消除酒精中毒仍然是所有肝病学家都认可的最重要的一点。
