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アルコール に 関する 肝臓 疾患 の 診断 と 治療 ― 概要
Ashwani K Singal1,2, Philippe Mathurin3
1University of South Dakota Sanford School of Medicine, Sioux Falls.
JAMA
|July 13, 2021
まとめ
アルコール関連肝疾患 (ALD) は 肝硬変に繋がり アメリカでは 何百万人も 罹患しています 早期のコルチコステロイド治療や肝臓移植は,重度のALDおよび非補償性肝硬変の生存率を向上させます.
科学分野:
- ヘパトロジー
- 胃腸内科
- 内科 医学
背景:
- アルコール関連肝疾患 (ALD) は,肝硬変,肝臓死亡,肝臓移植の重要な原因です.
- 2017年,米国では200万人以上がアルコール関連肝硬変を患っており,公衆衛生に重大な負担を及ぼしています.
- ALDは肝臓移植の主要な指標で,高所得国における移植の40~50%を占めています.
研究 の 目的:
- アルコール関連肝疾患の流行病学,リスク要因,管理についてまとめます.
- アルコール性肝炎と不補償性肝硬変の予後を強調する.
- 重度のALDの管理におけるコルチコステロイドと肝臓移植の役割を強調する.
主な方法:
- ステアトーシス,アルコール性肝炎,線維症を含むALDの病理学的発見のレビュー
- アルコール摂取パターン,性別,肥満,遺伝的多形性など,ALDの進行の危険因子の特定.
- アルコール禁断と再発に基づく生存データの分析
- コルチコステロイド治療と肝臓移植の治療結果の評価
主要な成果:
- アルコール性肝炎は肝硬変の進行のリスクが最も高い.
- ALDの危険因子には,アルコール使用量/期間,女性,肥満,特定の遺伝子変異が含まれます.
- アルコール禁断は,再発 (73%) と比べて,10年生存率 (88%) が有意に向上した.
- 症状のあるアルコール性肝炎は1年以内に30%の死亡リスクを持ち,重症症例は急性/慢性肝不全と関連しています.
- コルチコステロイド治療は重度のアルコール性肝炎の1ヶ月生存率を65%から80%まで改善します.
- 肝臓移植は,薬物治療に反応しない重度のアルコール性肝炎の患者,および不補償性肝硬変の患者 (3ヶ月間の禁酒後のMELDスコア> 17) について決定的に重要です.
- ALDの肝臓移植候補者の割合は2014年から2019年の間に22%から40%に増加しました.
結論:
- アルコール関連の肝臓病や肝硬変は 高い割合で発生し 何百万もの患者を抱え 肝臓関連の死亡率に大きく貢献しています
- コルチコステロイド治療は,重度のアルコール性肝炎患者の生存率を改善するのに有効です.
- 肝臓移植は,アルコールの影響による肝臓不全の患者にとって最も効果的な治療法です.
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