Các khuôn mẫu mới trong quản lý viêm gan do rượu: một bài tổng quan

Hepatology International - Tập 11 - Trang 255-267 - 2017
Sandeep Singh Sidhu1, Omesh Goyal1, Harsh Kishore1, Simran Sidhu2
1Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India
2Himalayan Institute of Medical Sciences, Dehradun, India

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.

Từ khóa

#viêm gan do rượu #viêm gan nặng #tử vong #điều trị #cấy ghép gan

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