Alcoholic hepatitis: current challenges and future directions.

Alcoholic hepatitis is a distinct clinical syndrome amongst people with chronic and active alcohol abuse with a potential for 30–40% mortality at one month amongst those with severe disease. Corticosteroids or pentoxifylline are the current pharmacological treatment options but provide only about 50% survival benefit. These agents are recommended for patients with modified discriminant function (mDF) of ≥32 or model for end-stage disease (MELD) score of ≥18. The Lille score is used to determine response to steroids. Currently, a minimum of 6 months abstinence from alcohol use is required for patients to receive a liver transplant, a requirement that cannot be met by patients with severe alcoholic hepatitis non-responsive to steroids (Lille score ≥0.45). Data are emerging on the benefit of liver transplantation in select patients with first episode of severe alcoholic hepatitis. This review also focuses on recent treatment trials in alcoholic hepatitis including liver transplantation and its associated controversies, as well as possible future targets and pharmacological treatment options for patients with alcoholic hepatitis that are being pursued through upcoming consortium studies.

酒精性肝炎是慢性且酗酒活跃人群中一种独特的临床综合征，重症患者在一个月内可能有30% - 40%的死亡率。皮质类固醇或己酮可可碱是目前的药物治疗选择，但仅提供约50%的生存益处。这些药物推荐用于改良判别函数（mDF）≥32或终末期肝病模型（MELD）评分≥18的患者。里尔评分用于确定对类固醇的反应。目前，患者需要戒酒至少6个月才能接受肝移植，而对类固醇无反应的重症酒精性肝炎患者（里尔评分≥0.45）无法满足这一要求。关于在部分首次发作重症酒精性肝炎患者中进行肝移植的益处的数据正在不断涌现。本综述还关注酒精性肝炎近期的治疗试验，包括肝移植及其相关争议，以及通过即将开展的联合研究正在探索的酒精性肝炎患者可能的未来治疗靶点和药物治疗选择。