Woods S E, Hitchcock M, Meyer A
Duke University Medical Center, Durham, North Carolina.
Am Fam Physician. 1993 Apr;47(5):1171-8.
Anorexia, weight loss, fatigue, symptoms of alcohol withdrawal and hepatomegaly are common early presenting signs and symptoms of alcohol abuse. The clinical diagnosis of alcoholic hepatitis can be made in alcoholics with associated fever, leukocytosis, jaundice and tender hepatomegaly. Associated laboratory abnormalities may include leukocytosis or leukopenia, anemia, a prolonged prothrombin time and elevated liver enzymes, including aspartate amino-transferase (AST), alanine aminotransferase (ALT), alkaline phosphatase and bilirubin. An AST-to-ALT ratio greater than 2 is common in patients with alcoholic hepatitis. Liver biopsy may be required to establish the diagnosis and to identify other pathology, such as cirrhosis. Histologic diagnosis of alcoholic hepatitis requires the presence of liver cell damage, an inflammatory infiltrate and fibrosis. Biopsy-proven cirrhosis with alcoholic hepatitis or a significantly elevated total bilirubin level and prolonged prothrombin time are associated with a worse prognosis. Abstinence from alcohol, nutritional supplementation and corticosteroids are the mainstays of treatment for severe alcoholic hepatitis.
厌食、体重减轻、疲劳、酒精戒断症状和肝肿大是酒精滥用常见的早期表现体征和症状。酒精性肝炎的临床诊断可在伴有发热、白细胞增多、黄疸和肝肿大压痛的酗酒者中做出。相关的实验室异常可能包括白细胞增多或白细胞减少、贫血、凝血酶原时间延长以及肝酶升高，包括天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、碱性磷酸酶和胆红素。酒精性肝炎患者中AST与ALT的比值大于2很常见。可能需要进行肝活检以明确诊断并识别其他病理情况，如肝硬化。酒精性肝炎的组织学诊断需要存在肝细胞损伤、炎症浸润和纤维化。活检证实的伴有酒精性肝炎的肝硬化或总胆红素水平显著升高及凝血酶原时间延长与预后较差相关。戒酒、营养补充和使用皮质类固醇是重度酒精性肝炎治疗的主要方法。
