Leevy C B, Leevy C M
New Jersey Medical School Liver Center, Newark.
Compr Ther. 1994;20(1):6-9.
Alcoholism alone, or in combination with other etiologic factors, is a common cause of liver failure because of hepatitis, cirrhosis, and/or hepatocellular cancer. Encountered morphologic and functional alterations are due to immunologic reactivity to cell injury evoked by acetaldehyde, other noxious factors, and nutrient deficits. Less than 20% of subjects who consume over 90 g/d of ethanol for years develop progressive liver damage and cirrhosis. Alcoholism should be interrupted in patients with subclinical hepatic abnormalities. Although early alcoholic hepatitis and cirrhosis respond to abstinence and symptomatic therapy, available measures have little influence on functional and morphologic abnormalities in end-stage alcoholic liver disease. Resection is desirable for localized hepatocellular cancer, and liver transplantation should be considered for cirrhosis. Transplantation is appropriate for patients with uncomplicated end-stage alcoholic cirrhosis in whom evidence of liver failure can be controlled during a 6-month period of rehabilitation. Continuous psychosocial support is required to prevent recividism in the posttransplant immunosuppressed alcoholic.
酒精中毒单独或与其他病因因素共同作用，是因肝炎、肝硬化和/或肝细胞癌导致肝衰竭的常见原因。所遇到的形态学和功能改变是由于对乙醛、其他有害因素及营养缺乏引起的细胞损伤产生免疫反应所致。多年来每天摄入乙醇超过90克的受试者中，不到20%会发生进行性肝损伤和肝硬化。对于有亚临床肝脏异常的患者，应戒酒。虽然早期酒精性肝炎和肝硬化对戒酒及对症治疗有反应，但现有措施对终末期酒精性肝病的功能和形态学异常影响甚微。对于局限性肝细胞癌，手术切除是可取的，对于肝硬化患者应考虑肝移植。对于在6个月康复期内肝功能衰竭证据可得到控制的无并发症终末期酒精性肝硬化患者，移植是合适的。对于移植后免疫抑制的酗酒者，需要持续的社会心理支持以防止复发。
