酒精性肝病的诊断与治疗

:11,200001;21/,200080E-mail:fattyliver2004@1261com1,21005-2194(2007)01-0021-03R5A;;;KeywordsAlcoholicliverdisease;Clinicaltyping;Liver-protectiveagent;Alcoholwithdrawal,,,,,,(alcoholicliverdisease,ALD),;ALD,,[1-3],20062[4],1111ALDALD5,40g/d,20g/d;2,80g/d[(g)=(mL)(%)018],,,112CAGEAUDIT(AST)(ALT)2,-(GGT)(MCV),,113ALD,,,,,400U/L,,114,115,ALD,ALD;Mallory;;;12200712712ALD211,:(1),;(2),,,;(3),2,;(4),[1]212,ALD5[1,3],213,ALDALD,,(8515mol/L),3s[1,3-4]-Maddrey[416(s)+(mg/dL)],Maddrey32450%,Child-Pugh,ALD,214ALDzieve()-,()[1],ALD,,3311ALD,,,ALD;;[3-11],,();(),-(TNF-);,,312ALD,,:,,ALD,[7],,,313ALD-,(),,ALDB,[8],ALD314,S-ALD;ALD,,;,[1-3,9-10]315Maddrey32()(40mg/d28d),,-B(NF-B);(),TNF-(400mg,3,,28d);TNF-22CHINESEJOURNALOFPRACTICALINTERNALMEDICINEJan2007Vol127No11(infliximab),50%10%[3-6,9]316,(HCC)BHCC,ALDHBVHCVHCC,HCC[1,3]317ALD,3,;6[11]4ALD,,,,,ALD,48,,[2,4][1],.[M].:,2005:366-410.[2]TumaDJ,SorrellM.Alcoholandalcoholicliverdisease[J].SeminLiverDis,2004,24:215.[3]LevitskyJ,MailliardME.Diagnosisandtherapyofalcoholicliv2erdisease[J].SeminLiverDis,2004,24:233-247.[4].[J].,2006,11:66-68.[5]McCulloughAJ,OpConnorJF.Alcoholicliverdisease:proposedrecommendationsfortheAmericanCollegeofGastroenterology[J].AmJGastroenterol,1998,93:2022-2036.[6]StewartSF,DayCP.Themanagementofalcoholicliverdisease[J].JHepatol,2003,38:2-13.[7].:[J].,2003,11:645-646.[8]StickelF,HoehnB,SchuppanD,etal.Reviewarticle:nutri2tionaltherapyinalcoholicliverdisease[J].AlimentPharmacolTher,2003,18:357-373.[9],.[J].,2003,11:703-704.[10]MedinaJ,Moreno-OteroR.Pathophysiologicalbasisforan2tioxidanttherapyinchronicliverdisease[J].Drugs,2005,65:2445-2461.[11]MurrayKF,CarithersRLJR.AASLDpracticeguidelines:eval2uationofthepatientforlivertransplantation[J].Hepatology,2005,41:1407-1432.2006-10-09:,2006,!:9(5):110001:024-23877722(024)::23874411:23866512;23866510;23866511;23866513;23866516;23866520;23866522;23866523;23866525;23866526;23866580:23866530;23866533:024-238665203220071271