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酒精性肝炎：临床表现及诊断

Author
Scott L Friedman, MD
Section Editor
Bruce A Runyon, MD
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
严雪敏, 主治医师

引言

过量饮酒会导致一系列肝脏表现，包括酒精性脂肪性肝病(伴或不伴脂肪性肝炎)、酒精性肝炎及肝硬化。尽管酒精导致的无症状性脂肪性肝炎也可被称为“酒精性肝炎”，但该术语通常用于描述有症状的肝炎急性发作。使个体置身酒精性肝炎风险的酒精摄入量尚不清楚，但大多数患者有持续20年或更长时间的大量饮酒(酒精摄入超过100g/d)史(图 1)[1-3]。一旦酒精性肝炎急性发作得到缓解，临床医生不应该忽略酒精使用障碍需要长期鼓励治疗[4]。 (参见“酒精使用障碍：流行病学、发病机制、临床表现、不良后果和诊断”)

本专题将总结酒精性肝炎的临床表现及诊断。酒精性肝炎的治疗、酒精性肝脏疾病的发病机制及酒精性脂肪性肝病或酒精性肝硬化的诊断治疗方法等相关内容将单独讨论。 (参见“酒精性肝炎：自然病程和治疗”和“酒精性肝病的发病机制”和“酒精性脂肪性肝病和酒精性肝硬化的临床表现和诊断”和“酒精性脂肪肝和酒精性肝硬化的预后和管理”)

2010年美国肝病研究学会发布了酒精性肝病患者的治疗指南[5]。以下讨论与这些指南基本一致。

病史

酒精性肝炎患者常常在40-50岁之间，大多数患者在60岁前就诊[6]。酒精性肝炎患者通常有超过20年的每日大量饮酒史(酒精摄入超过100g/d)(图 1)，在某些病例中，患者会因近期应激性生活事件刺激而增加饮酒量[7]。患者出现病况后多会停止饮酒，所以常发现患者在就诊前几周已停止饮酒[1,2,8,9]。然而，饮酒模式可能有所不同，患者可能是间断性(即仅在周末)或秘密地大量饮酒，这样家人、朋友或同事可能不会察觉到这种问题性饮酒模式。此外，大量饮酒史短得多的患者亦可发生酒精性肝炎[10]。

从疑似酒精性肝炎患者那里可能难以获得准确的饮酒史。在患者允许与其家人讨论治疗后，私下询问患者家属可能有助于找出有关患者饮酒的重要信息。医疗保健人员绝对有必要仔细询问饮酒史，辅以CAGE问卷或酒精使用障碍筛查量表(Alcohol Use Disorders Identification Test, AUDIT)以明确问题性饮酒或酗酒的可能性(表 1和表 2)。 (参见“酒精和其他药物不健康使用的筛查”，关于‘不健康的酒精使用’一节)

                 

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Literature review current through: 2017-06 . | This topic last updated: 2016-12-15.
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