Wrona S A, Tankanow R M
University of Michigan Medical Center, Ann Arbor.
Am J Hosp Pharm. 1994 Feb 1;51(3):347-53.
The pathophysiology of alcoholic hepatitis and the use of corticosteroids in the management of alcoholic hepatitis are described. Alcoholic hepatitis is a chronic, progressive, often fatal disease. Symptoms may be absent or may range from mild to severe, with little correlation between clinical and histologic findings. A definitive diagnosis can be made only through histologic examination of the liver. Biochemical liver tests may help in diagnosing or staging alcoholic hepatitis. Prognosis depends on the extent of underlying liver disease, the presence of other complications of liver disease, concomitant disease states, and abstinence from use of alcohol. Therapy has traditionally consisted of supportive care. Corticosteroids have been widely studied in the management of alcoholic hepatitis, but lack of consistency in time to treatment, proportion of female subjects, and disease severity make it difficult to draw conclusions from these studies. Data suggest that corticosteroid therapy may reduce short-term mortality among patients with alcoholic hepatitis who also have hepatic encephalopathy. This beneficial effect depends on the absence of gastrointestinal bleeding. Corticosteroid therapy may be warranted in patients with alcoholic hepatitis with encephalopathy but no gastro-intestinal bleeding. Further trials are needed to assess the long-term benefit of corticosteroids and to determine the optimum dosage.
本文描述了酒精性肝炎的病理生理学以及皮质类固醇在酒精性肝炎治疗中的应用。酒精性肝炎是一种慢性、进行性且往往致命的疾病。症状可能不存在，也可能从轻微到严重不等，临床和组织学表现之间几乎没有相关性。只有通过肝脏组织学检查才能做出明确诊断。肝脏生化检查可能有助于诊断或对酒精性肝炎进行分期。预后取决于潜在肝病的程度、是否存在其他肝病并发症、伴随的疾病状态以及是否戒酒。传统上，治疗包括支持性护理。皮质类固醇在酒精性肝炎的治疗中已得到广泛研究，但治疗时间、女性受试者比例和疾病严重程度缺乏一致性，使得难以从这些研究中得出结论。数据表明，皮质类固醇治疗可能会降低同时患有肝性脑病的酒精性肝炎患者的短期死亡率。这种有益效果取决于是否没有胃肠道出血。对于患有肝性脑病但无胃肠道出血的酒精性肝炎患者，可能有必要进行皮质类固醇治疗。需要进一步的试验来评估皮质类固醇的长期益处并确定最佳剂量。
