酒精性肝硬化怎样治疗

酒精性肝硬化如何治疗配图，仅供参考

TREATMENT OF ALCOHOLIC LIVER DISEASE
# General measures
General measures in ALD include abstinence from alcohol,lifestyle modifications and the correction of nutritional deficiencies.
Alcohol abstinence is one of the most important measures in managing ALD,since it leads to a decrease in the severity of liver lesions and improves survival even in advanced stages of ALD. Behavioral and psychosocial interventions such as cognitive-behavioral therapy,psychodynamic approaches,therapeutic communities or vocational rehabilitation may be useful. Most of the proposed treatments for promoting alcohol abstinence in ALD patients were tested within small trials and no large multicenter studies have been conducted.
In alcoholic cirrhosis,cessation of alcohol intake remains the most important measure to prevent decompensation and no other management strategies exist,as is the case with other causes of cirrhosis.
Nutritional status should be balanced in the case of malnutrition. A daily protein intake of 1.5 g/kg and 35-40kcal/kg of body weight per day are recommended in ALD patients. Supplementation with folate,pyridoxine,vitamin A and thiamine is required if these deficits are observed. The usage of some antioxidants such as vitamin E or silymarin has not been proved to be effective.
# Alcoholic hepatitis
Despite the fact that corticosteroids have been the most extensively studied therapy for alcoholic hepatitis,their role remains controversial. Multiple differences in trial design with a high risk of bias may explain the variability of meta-analyses results. The most recent Cochrane meta-analysis which included 15 trials reported that corticosteroids significantly reduced mortality in the subgroup of trials that enrolled patients with a Maddrey’s DF ≥ 32 or hepatic encephalopathy. The main contraindications to using corticosteroids in severe alcoholic hepatitis (DF ≥ 32) are sepsis,hepatorenal syndrome,chronic hepatitis B,gastrointestinal bleeding and other clear contraindications to steroids.
Pentoxifylline,a phosphodiesterase with anti-TNF properties,antifibrotic and antioxidant effects,can be used to treat patients with severe alcoholic hepatitis when corticosteroid therapy is contraindicated. The survival benefit of pentoxifylline vs corticosteroids appears to be linked to the lower occurrence of gastrointestinal bleeding,and to a marked reduction in the incidence of the hepatorenal syndrome.
Two anti-TNF-α agents have been studied as therapy for alcoholic hepatitis (infliximab and etanercept),but clinical trials showed that these drugs are associated with severe infections and deaths.
N-acetylcysteine,an antioxidant substance,used in combination with corticosteroids decreases the rate of hepatorenal syndrome and infections.
S-adenosylmethionine (SAMe) is a major methylating agent that influences oxidative stress,mitochondrial function and hepatocellular apoptosis. Although SAMe may offer clinical benefits in ALD,very few large and high-quality clinical trials have been performed.
Probiotics influence the gut-liver axis and have been shown to be efficacious in numerous studies.
Liver transplantation is currently the only definitive treatment for hepatic failure associated with ALD. Previous expert opinions considering alcoholic hepatitis as a contraindication for liver transplantation have recently been reconsidered by a case controlled study which showed a clear improvement of survival in patients who underwent early liver transplantation.
New targets for ALD therapy includes CXC chemokines (GROα,IL-8),Interleukin-22 and the complement system.","department":"