重症酒精性肝炎与慢加急性肝衰竭  

Severe alcoholic hepatitis and acute-on-chronic liver failure

作　　者：孙福荣[1] 王炳元[1] SUN Furong;WANG Bingyuan(Department of Elderly Gastroenterology, the First Hospital of China Medical University, Shenyang 118001, China)

机构地区：[1]中国医科大学附属第一医院老年消化科,沈阳118001

出　　处：《临床肝胆病杂志》2019年第3期489-493,共5页Journal of Clinical Hepatology

摘　　要：酒精性肝炎(AH)患者出现以快速进展或加重的黄疸、凝血异常及肝脏相关并发症等为主的表现,往往提示发生重症AH的可能。在感染、大量饮酒等诱因的作用下,部分患者短期内病情迅速进展,不仅导致肝功能急性失代偿,并且出现以器官功能衰竭和较高的28d病死率等为主要特征的慢加急性肝衰竭(ACLF)。早期识别ACLF并予以有效干预能够改善预后。肠道屏障功能障碍与肝-肠轴失衡在重症AH和ACLF的发展中发挥重要作用。应积极改善患者的营养状态,但药物治疗对改善ACLF病情和预后的作用有限。早期肝移植能够为患者带来更多获益。Rapid progression or aggravation of jaundice, coagulation abnormalities and liver-related complications in patients with alcoholic hepatitis indicates that they may develop severe alcoholic hepatitis. Some of these patients can progress acute-on-chronic liver failure with acute insults, such as infection and binge drinking and binge, showing as acute decompensation, organ failure and high 28-day mortality rate. Early identification and effective intervention can improve the prognosis of acute-on-chronic liver failure. Intestinal barrier dysfunction and liver-gut axis imbalance play an important role in the development of severe alcoholic hepatitis and acute-on-chronic liver failure. It is important to improve the basic nutritional status of patients. Effective drug therapies are limited in improving the condition and prognosis of acute-on-chronic liver failure. Early liver transplantation can bring great benefits to these patients.

关 键 词：肝炎 酒精性 慢加急性肝衰竭 病理过程 危险性评估 治疗学 

分 类 号：R575.1[医药卫生—消化系统] R575.3[医药卫生—内科学]