酒精性肝病

最后审阅: 17 四月 2022
最后更新: 24 八月 2021

小结

定义

病史和体格检查

关键诊断因素

  • 存在的危险因素
  • 腹痛
  • 肝肿大
  • 呕血和黑便
  • 静脉侧支循环
  • 脾肿大
  • 肝脏肿块
  • 黄疸
  • 肝掌
  • 皮肤毛细血管扩张
  • 扑翼样震颤
更多 关键诊断因素

其他诊断因素

  • 腹水
  • 体重减轻
  • 体重升高
  • 营养不良与消瘦
  • 厌食
  • 疲劳
  • 意识模糊
  • 瘙痒
  • 发热
  • 恶心和呕吐
  • 杵状指
  • 掌腱膜挛缩症
  • 腿肿胀
  • 腮腺肿大
  • 男性乳房发育
  • 性腺机能减退症
  • 痴呆
  • 周围神经病
其他诊断因素

危险因素

  • 长期大量饮酒
  • 丙型肝炎
  • 女性
  • 吸烟
  • 肥胖
  • 年龄> 65 岁
  • 西班牙人
  • 遗传易感性
更多 危险因素

诊断性检查

首要检查

  • 血清天门冬氨酸氨基转移酶 (AST) 和丙氨酸氨基转移酶(ALT)
  • 血清 AST/ALT 比值
  • 血清碱性磷酸酶
  • 血清胆红素
  • 血清白蛋白,蛋白质
  • 血清 γ-谷氨酰胺转移酶(γ-GT)
  • 全血细胞计数(FBC)
  • 血清电解质、镁、磷
  • 血清尿素和肌酐
  • 血清凝血酶原时间(PT)、国际标准化比值(INR)
  • 肝脏超声
更多 首要检查

需考虑的检查

  • 病毒性肝炎血清学分析
  • 血清铁、铁蛋白、转铁蛋白
  • 尿铜(收集 24 小时)
  • 血清铜蓝蛋白
  • 血清抗线粒体抗体(AMA)
  • 血清抗核抗体 (ANA)和抗平滑肌抗体( ASMA)
  • 血清 α-1 抗胰蛋白酶水平
  • 血清氨
  • 血清叶酸
  • 非侵入性的肝脏弹性检测
  • 腹部 CT 和磁共振成像
  • 肝脏活检
更多 需考虑的检查

新兴检查

  • 血清缺糖基转铁蛋白检测
  • 血清线粒体 AST

治疗流程

持续性治疗

所有患者

撰稿人

作者

Craig McClain, MD
Craig McClain

Professor

Chief of Research Affairs

Associate Vice President for Health Affairs/Research

Division of Gastroenterology, Hepatology and Nutrition

Department of Medicine

University of Louisville School of Medicine

Louisville

KY

利益声明

CM acts as a consultant for Nestlé, Durect, Allergan, Intercept and DISCUS. He works for the Veterans Administration on a part time basis, has received grants from the NIH and VAMC, and is working on the update of the AGC nutritional guideline..

Luis Marsano, MD
Luis Marsano

Professor and Director of Hepatology

Division of Gastroenterology, Hepatology and Nutrition

Department of Medicine

University of Louisville School of Medicine

Louisville

KY

利益声明

LM is on the speaker bureau for Salix (maker of Rifaximin - Xifaxan); Rifaximin is part of the therapy (supported by practice guidelines) of hepatic encephalopathy. He is also on the speaker bureau of Grifols (one of the makers of albumin for intravenous infusion); albumin is used as part of the treatment of spontaneous bacterial peritonitis (supported by practice guidelines).

鸣谢

Dr Craig McClain and Dr Luis Marsano would like to gratefully acknowledge Dr Mihir Patel, a previous contributor to this topic.

利益声明

MP declares that he has no competing interests.

同行评议者

Lorenzo Leggio, MD, MSc

Postdoctoral Research Associate

Center for Alcohol and Addiction Studies

Brown University

Providence

RI

利益声明

LL declares that he has no competing interests.

Nancy Reau, MD

Assistant Professor of Medicine

University of Chicago

Center for Liver Disease

Chicago

IL

利益声明

NR declares that she has no competing interests.

Nick Sheron, MD, FRCP

Head of Clinical Hepatology and Senior Lecturer

Division of Infection, Inflammation and Immunity

University of Southampton Medical School

Southampton General Hospital NHS Trust

Southampton

UK

利益声明

NS has received research grants from the Medical Research Council (MRC), Wellcome Trust, British Liver Trust, Alcohol Education Research Council, and various other funding bodies. He has undertaken paid consultancy work and received travelling expenses from pharmaceutical companies developing drugs for the treatment of inflammatory bowel disease and liver disease. He has been paid for medico-legal work in the areas of hepatitis C and alcohol-related liver disease. The following memberships and advisory work are unpaid apart from travelling expenses: EU Alcohol Forum, EU Alcohol Marketing Taskforce, Royal College of Physicians Alcohol Committee, Alcohol Health Alliance UK. NS has undertaken advisory and media work for the UK Department of Health, Home Office, Department of Transport, Cross Cabinet Strategy Committee, National Institute for Health and Care Excellence, Southampton City Council, UK Police, and British Liver Trust, and various other NGOs, local government, and other bodies. NS is an unpaid trustee of the Drinkaware Trust, an independent body set up by the UK Government to use industry resources to reduce alcohol-related harm. The Trust is funded entirely by the alcohol industry, with a board of trustees comprising 5 industry members, 5 members with alcohol-related health expertise, and 3 lay members.

Alastair MacGilchrist, MD, FRCP

Consultant Hepatologist

Royal Infirmary of Edinburgh

Edinburgh

UK

利益声明

AM declares that he has no competing interests.

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