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Các khuôn mẫu mới trong quản lý viêm gan do rượu: một bài tổng quan
Tóm tắt
Viêm gan do rượu nặng (SAH) được xác định bởi chức năng phân biệt Maddrey đã được điều chỉnh ≥32 hoặc Mô hình Bệnh gan giai đoạn cuối (MELD) >21 và/hoặc sự suy não gan. Tỷ lệ tử vong trong 3 tháng ≥30–70%. Bệnh nhân mắc viêm gan do rượu nặng cần được dự đoán tiên lượng kết hợp, tức là tĩnh (điểm số MELD) và động (điểm số Lille). Viêm toàn thân và khả năng tái tạo kém là những dấu hiệu điển hình của SAH, chứ không phải viêm nội gan. SAH đặc trưng bởi phản ứng viêm hệ thống không được điều chỉnh và không kiểm soát, sau đó là phản ứng chống viêm bù đắp yếu, dẫn đến tăng độ nhạy cảm với nhiễm trùng và suy đa tạng. Hoại tử to lớn của tế bào gan vượt quá khả năng tăng sinh của chúng. Các tế bào gốc gan tăng sinh để hình thành các ống nhỏ hẹp, tỏa ra vào nhu mô gan bị tổn thương. Corticosteroid đã được sử dụng theo tiêu chuẩn điều trị, mặc dù còn gây tranh cãi. Tuy nhiên, thử nghiệm gần đây về Steroids or Pentoxifylline for Alcoholic Hepatitis (STOPAH) cho thấy prednisolone không liên quan đến việc giảm tỷ lệ tử vong ở 28 ngày một cách đáng kể, mà không cải thiện kết quả ở 90 ngày hoặc 1 năm. Một sự thay đổi mô hình từ liệu pháp chống viêm như corticosteroid sang điều trị tái tạo gan, ví dụ, yếu tố kích thích dòng bạch cầu, các phương pháp điều trị nhắm tế bào phân tử và cấy ghép vi sinh vật phân tích đang diễn ra cho viêm gan do rượu nặng. Cấy ghép gan nên được cung cấp cho những bệnh nhân chọn lọc bị viêm gan do rượu nặng mà không đáp ứng với điều trị y tế.
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#viêm gan do rượu #viêm gan nặng #tử vong #điều trị #cấy ghép ganTài liệu tham khảo
Lucey MR, Mathurin P, Morgan TR. Alcoholic hepatitis. N Engl J Med 2009;2009(360):2758–2769
O’Shea RS, Dasarathy S, McCullough AJ. The Practice Guideline Committee of the American Association for the Study of Liver Diseases and the Practice Parameters Committee of the American College of Gastroenterology. Alcoholic liver disease. Hepatology 2010;2010:307–328
Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of person with harmful alcohol consumption-II. Addiction 1993;1993(88):791–804
Childer RE, Joseph AH. Diagnosis of alcoholic hepatitis liver disease. Clin Liver Dis 2016;2016(20):457–471
Heuman DM, Hung PD. Alcoholic hepatitis. Drug and disease. Gastroenterology. http://emedicine.medscape.com/article/170539-overview
Crabb DW, Bataller R, Chalasani NP, Kamath PS, Lucey M, Mathurin P, et al. Standard definitions and common data elements for clinical trials in patients with alcoholic hepatitis: recommendation from the NIAAA alcoholic hepatitis consortia. Gastroenterology 2016;150(4):785–790
Kato M, Kato S, Horiuchi S, Nagai K, Horie Y, Hayashi K. Mallory bodies in hepatocytes of alcoholic liver disease and primary biliary cirrhosis contain-(carboxymethyl) lysine-modified cytokeratin, but not those in hepatic carcinoma cells. Yonago Acta Med 2006;49:83–92
EASL Clinical Practical Guidelines. Management of alcoholic liver disease. J Hepatol 2012;57:399–420
Hanouneh IA, Zein NN, Cikach F, Dababneh L, Grove D, Alkhouri N, et al. The breath prints in patients with liver disease identify novel breath biomarkers in alcoholic hepatitis. Clin Gastroenterol Hepatol 2014; 12(3): 516–523
Sidhu SS, Goyal O, Singla P, Sood A, Chhina RS, Soni RK. Corticosteroid plus pentoxifylline is not better than corticosteroid alone for improving survival in severe alcoholic hepatitis (COPE Trial). Dig Dis Sci 2012;57(6):1664–1671
Singh V, Sharma KA, Narasimhan RL, Bhalla A, Sharma N, Sharma R. Granulocyte colony-stimulating factor in severe alcoholic hepatitis: a randomized pilot study. Am J Gastroenterol 2014;2014(109):1417–1423
Dominguez M, Rincon D, Abraldes JG, Miquel R, Colmenero J, Bellot P, et al. A new scoring system for prognostic stratification of patients with alcoholic hepatitis. Am J Gastroenterol 2008;2008(103):2747–2756
O’Shea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Am J Gastroenterol 2010;2010(105):14–32
Arteel GE. Build a better mouse model, and the world will beat a path to your door. Hepatology 2013;58(5):1526–1528
Kakiyama G, Pandak WM, Gillevet PM, Hylemon PB, Heuman DM, Daita K, et al. Modulation of the fecal bile acid profile by gut microbiota in cirrhosis. J Hepatol 2013;58(5):949–955
Zhong W, McClain CJ, Cave M, Kang YJ, Zhou Z. The role of zinc deficiency in alcohol-induced intestinal barrier dysfunction. Am J Physiol Gastrointest Liver Physiol 2010;298(5):G625–G633
Setshedi M, Wands JR, Monte SM. Acetaldehyde adducts in alcoholic liver disease. Oxid Med Cell Longev 2010; 3(3): 178–185
Dunn W, Shah VH. Pathogenesis of alcoholic liver disease. Clin Liver Dis 2016;2016(20):445–456
Alpert L, Hart J. The pathology of alcoholic liver disease. Clin Liver Dis 2016;2016(20):473–489
Vessey Carina J, Pauline M, De La Hall M. Hepatic stem cells: a review. Pathology 2001;33:130–141
Altamirano J, Miquel R, Katoonizadeh A, Abraldes JG, Rojo AD, Louvet A, et al. A histologic scoring system for prognosis of patients with alcoholic hepatitis. Gastroenterology 2014; 146(5):1231–1239
Louvet A, Labreuche J, Artru F, Boursier J, Kim DJ, O’Grady J, et al. Combining data from liver disease scoring systems better predicts outcomes of patients with alcoholic hepatitis. Gastroenterology 2015;149(2): 398–406
Rachakonda V, Gabbert C, Raina A, Li H, Malik S, DeLany JP, et al. Stratification of risk of death in severe acute alcoholic hepatitis using a panel of adipokines and cytokines. Alcohol Clin Exp Res 2014;2014(38):2712–2721
Jonas DE, Amick HR, Feltner C, Bobashev G, Thomas K, Wines R, et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA 2014; 311:1889
Mason BJ. Acamprosate in the treatment of alcohol dependence. Expert Opin Pharmacother 2015;2005(6):2103–2115
Frazier TH, Stocker AM, Kershner NA, Marsano LS, McClain CJ. Treatment of alcoholic liver disease. Therap Adv Gastroenterol 2011; 4(1): 63–81
Kaisdotter A, Kron J, Castren M, Athlin AM, Hok B, Wiklund L. Assessment of the breath alcohol concentration in emergency care patients with different level of consciousness. Scand J Trauma Resusc Emerg Med 2015; 23:11
Piano SM, Rosi S, Cavallin M, Romano A, Gola E, Marchioro L, et al. Urinary ethyl glucuronide improves the detection of alcohol consumption in liver transplantation candidates and recipients. Hepatology 2012;56:977A
Sterneck MA, Staufer K, Schulz KH, Nashan B. Ethyl glucuronide determination in hair for evaluation of long-term alcohol abstention in liver transplant candidates. Hepatology 2012;56:493A
Mezey E. Interaction between alcohol and nutrition in the pathogenesis of alcoholic liver disease. Semin Liver Dis 1991;1991(11):340–348
Mendenhall CL, Anderson S, Weesner RE, Goldberg SJ, Crolic KA. Protein-calorie malnutrition associated with alcoholic hepatitis. Veterans Administration Cooperative Study Group on Alcoholic Hepatitis. Am J Med 1984;1984(76):211–222
Moreno C, Deltenre P, Senterre C, Louvet A, Gustot T, Bastens B, et al. Intensive enteral nutrition is ineffective for patients with severe alcoholic hepatitis treated with corticosteroids. Gastroenterology 2016;2016(150):903–910
Sinclair M, Gow PJ, Grossmann M, Angus PW. Review article: sarcopenia in cirrhosis-aetiology, implications and potential therapeutic interventions. Aliment Pharmacol Ther 2016;43(7):765–777
Montano-Loza AJ, Meza-Junco J, Prado CMM, Tandon P, Bain VG, Ma M, et al. New cutoff values for sarcopenia for predicting 6-month mortality in cirrhotic patients. J Hepatol 2013;58(Suppl):S95
Puri P, Thurz M. Intensive enteral nutrition in alcoholic hepatitis: more food for thought. Gastroenterology 2016; 150(4): 803–805
Taieb J, Mathurin P, Elbim C, Cluzel P, Arce-Vicioso M, Bernard B, et al. Blood neutrophil functions and cytokine release in severe alcoholic hepatitis: effect of corticosteroids. J Hepatol 2000;2000(32):579–586
Han J, Thompson P, Beutler B. Dexamethasone and pentoxifylline inhibit endotoxin-induced cachectin/tumor necrosis factor synthesis at separate points in the signaling pathway. J Exp Med 1990;1990(172):391–394
Thursz M, Richardson P, Allison M, Austin A, Bowers M, Christopher P, et al. Prednisolone or pentoxifylline for alcoholic hepatitis. N Engl J Med 2015;2015(372):1619–1628
Thursz MR, Louvet A, Kim DJ, Labreuche J, Atkinson SR, Sidhu S, et al. Corticosteroids are the only remaining pharmacological option for severe alcoholic hepatitis: a meta-analysis of individual data on 1974 patients. In Paper presented at AASLD
Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O. Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial. Gastroenterology 2015;2000(119):1637–1648
Sidhu SS, Goyal O, Singla M, Bhatia KL, Chhina RS, Sood A. Pentoxiphylline in severe alcoholic hepatitis: a prospective, randomized trial. J Assoc Phys India 2012;2011(69):20–22
Whitfield K, Rambaldi A, Wetterslev J, Gluud C. Pentoxifylline for alcoholic hepatitis. Cochrane Database Syst Rev 2009; CD007339
Louvet A, Diaz E, Dharancy S. Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids. J Hepatol 2008;2008(48):465–470
Mathurin P, Louvet A, Duhamel A, Nahon P, Carbonell N, Boursier J, et al. Prednisolone with vs without pentoxifylline and survival of patients with severe alcoholic hepatitis. A randomized clinical trial. JAMA 2013;310(10):1033–1041
Nguyen-khac E, Theevenot T, Benferhat S, Goria O, Chatelain D, Tramier B, et al. Glucocorticoids plus N-acetyl cysteine in severe alcoholic hepatitis. N Engl J Med 2011;365:1781–1789
Centre Hospitalier Universitaire, Amiens. Treatment of Severe Alcoholic Hepatitis with Corticoids Plus N Acetyl Cysteine Versus Corticoids Alone (HAA-NAC). https://clinicaltrials.gov/ct2/show/NCT00863785
Higuera-de la Tijera F, Servin-Caamano AI, Cruz-Herrera J, Serralde-Zuniga AE, Abdo-Francis JM, Gutierrez-Reyes G, et al. Treatment with metadoxine and its impact on early mortality in patients with severe alcoholic hepatitis. Ann Hepatol 2014;13(3):343–352
Higuera-de la Tijera F, Servin-Caamano AL, Serralde-Zuniga AE, Herrera JC, Torres EP, Abdo-Francis AM, et al. Metadoxine improves the three- and six-month survival rates in patients with severe alcoholic hepatitis. World J Gastroenterol 2015; 21(16): 4975–4985
Naveau S, Chollet-Martin S, Dharancy S, Jouet P, Piquet MA, Davion T, et al. A double-blind randomized controlled trial of infliximab associated with prednisolone in acute alcoholic hepatitis. Hepatology 2004;2004(39):1390–1397
Rambaldi A, Gluud C. Colchicine for alcoholic and non-alcoholic liver fibrosis and cirrhosis (review). Cochrane Database Syst Rev 2001;(3):CD002148
RambaldiAL, Iaquinto G, Gluud C. Anabolic-androgenic steroids for alcoholic liver disease. Cochrane Database Syst Rev 2003;(1):CD003045
Mato JM, Camara J, Fernandez J, Caballeria L, Coll S, Caballero A, et al. S-Adenosylmethionine in alcoholic liver cirrhosis: a randomized, placebo-controlled, double-blind, multicenter clinical trial. J Hepatol 1999;1999(30):1081–1089
Orrego H, Blake JE, Blendis LM, Compton KV, Israel Y. Long-term treatment of alcoholic liver disease with propylthiouracil. N Engl J Med 1987;1987(317):1421–1427
Morris JML, Dickson S, Neilson M, Hodgins P, Forrest EH. Granulocytapheresis in the treatment of severe alcoholic hepatitis: a case series. Eur J Gastroenterol Hepatol 2010;22(4):457–460
Jalan R, Sen S, Steiner C, Kapoor D, Alisa A, Williams R. Extracorporeal liver support with molecular adsorbents recirculating system in patients with severe acute alcoholic hepatitis. J Hepatol 2003(54):24–31
Louvet A, Naveau S, Abdelnour M, Ramond MJ, Diaz E, Fartoux L, et al. The Lille model: a new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 2007;2007(45):1348–1354
Dubuquoy L, Louvet A, Lassailly G, Truant S, Boleslawski E, Artru F, et al. Progenitor cell expansion and impaired hepatocyte regeneration in explanted livers from alcoholic hepatitis. Gut 2015;2015(64):1949–1960
Tato CM, Cua DJ. SnapShot: cytokines IV. Cell 2008; 132:1062
Rolas L, Makhezer N, Hadjoudj S, El-Benna J, Djerdjouri B, Elkrief L, et al. Inhibition of mammalian target of rapamycin aggravates the respiratory burst defect of neutrophils from decompensated patients with cirrhosis. Hepatology 2013;2013(57):1163–1671
Moreau R, Rautou PE. G-CSF therapy for severe alcoholic hepatitis: targeting liver regeneration or neutrophil function? Am J Gastroenterol 2014;2014(109):1424–1426
Kim DJ. Efficacy and Safety of Granulocyte-Colony Stimulating Factor in Patients with Severe Alcoholic Hepatitis with Null or Partial Response to Steroid: A Randomized, Double-Blind, Placebo-Controlled, Nationwide Multi-Center Study. https://clinicaltrials.gov/ct2/show/NCT02442180
Shasthry SM. Efficacy of G-CSF in the Management of Steroid Non-Responsive Severe Alcoholic Hepatitis. A Double Blind Randomized Control Trial. https://clinicaltrials.gov/ct2/show/NCT01820208
Struff WG, Sprotte G. Bovine colostrum as a biologic in clinical medicine: a review—Part II. Int J Clin Pharmacol Ther 2008;46:211–225
Kelly GS. Bovine colostrums: a review of clinical uses. Altern Med Rev 2003;8:378–394
Sidhu S, Goyal O, Kishore H. Corticosteroids and Bovine Colostrum in Treatment of Alcoholic Hepatitis ‘In Extremis’: A Pilot Study. In Paper Presented at Emerging Trends Conference in Alcohol Hepatitis. JW Marriott Miami, 22–23 January 2016
Virginia Commonwealth University. National Institute on Alcohol Abuse and Alcoholism (NIAAA). Safety and Efficacy of IMM 124-E for Patients with Severe Alcoholic Hepatitis (TREAT). https://clinicaltrials.gov/ct2/show/NCT01968382
Institute of Liver and Biliary Sciences, India. Pentoxyphilline Versus Fecal Microbiota Therapy in Severe Alcoholic Hepatitis. https://clinicaltrials.gov/ct2/show/NCT02458079
Philips CA, Pande A, Shasthry SM, Jamwal KD, Khillan V, Chandel SS, et al. Healthy donor fecal microbiota transplantation in steroid ineligible severe alcoholic hepatitis—a pilot study. Clin Gastroenterol Hepatol 2016;. doi:10.1016/j.cgh.2016.10.029
Efficacy Study of Anakinra, Pentoxifylline, and Zinc Compared to Methylprednisolone in Severe Acute Alcoholic Hepatitis. https://clinicaltrials.gov/ct2/show/NCT01809132
University Hospital, Lille. Efficacy of Antibiotic Therapy in Severe Alcoholic Hepatitis Treated with Prednisolone (AntibioCor). https://clinicaltrials.gov/ct2/show/NCT02281929
University of Texas South Western Medical Centre. Novel Therapies in Moderately Severe Acute Alcoholic Hepatitis (NTAH-Mod).https://clinicaltrials.gov/ct2/show/NCT01922895
Hospital Universitari Vall d’Hebron Research Institute. Effects of Rifaximin in Patients with Acute Alcoholic Hepatitis (RIFA-AAH). https://clinicaltrials.gov/ct2/show/NCT02116556
Helsinki University. Randomised Open-Label Multicentre Study Evaluating Ciprofloxacin in Severe Alcoholic Hepatitis. https://clinicaltrials.gov/ct2/show/NCT02326103
Conatus Pharmaceuticals Inc. Study of IDN-6556 in Patients with Severe Alcoholic Hepatitis and Contraindications to Steroid Therapy (AH). https://clinicaltrials.gov/ct2/show/NCT01912404.
Mayo Clinic. Use of F-652 in Patients with Alcoholic Hepatitis (TREAT 008). https://clinicaltrials.gov/ct2/show/NCT02655510.
Indiana University. Trial of Obeticholic Acid in Patients with Moderately Severe Alcoholic Hepatitis (TREAT 002). https://clinicaltrials.gov/ct2/show/NCT02039219.
Gilead Sciences. GS-4997 in Combination with Prednisolone Versus Prednisolone Alone in Participants with Severe Alcoholic Hepatitis. https://clinicaltrials.gov/ct2/show/NCT02854631.
Brown RS Jr. Transplantation for alcoholic hepatitis time to rethink the 6-month rule. N Engl J Med 2011;2011(365):1836–1838
Mathurin P, Moreno C, Samuel D, Dumortier J, Salleron J, Durand F, et al. Early liver transplantation for severe alcoholic hepatitis. N Engl J Med 2011;2011(365):1790–1800
