2013酒精性肝炎的诊断与处理（天坛）课件.ppt

Comparison of the elements that constitute 5 prognostic instruments in alcoholic hepatitis Maddrey score, Maddrey discriminant function GAHS, Glasgow Alcoholic Hepatitis Score ABIC score, age, serum Bilirubin, INR, and serum Creatinine MELD score, Model-for-End-Stage-Liver-Disease score 6. Major therapeutic measures （1） Abstinence Abstinence from alcohol reduces the risks of complications and mortality in patients with alcoholic cirrhosis and represents a major therapeutic goal (Recommendation A1) A speci?c analysis of fatality and its causes in alcoholic withdrawal syndrome (AWS) has rarely been made. misdiagnosis and missed diagnosis was frequent and very hight 250ml X 50% X 0.8 X 7 = 700 cal (2000cal/d 35%) Identification and management of cofactors, including obesity and insulin resistance, malnutrition, cigarette smoking, iron overload and viral hepatitis are recommended (Recommendation B1) （2）Nutritional supplements General recommendations for screening and management of complications of cirrhosis should be applied to patients with alcoholic cirrhosis (Recommendation A1) No specific pharmacological therapy for alcoholic cirrhosis has demonstrated unequivocal efficacy (Recommendation A1) Glycyrrhizic acid products, silymarin, polyene phosphatidylcholine and reduced glutathione have various degrees of anti-oxidative, antiinflammatory and hepatocyte membrane protective efficacy and can improve liver biochemical tests in some clinical trials (II-2, II-3). Bicyclol therapy can also alleviate the symptoms of ALD (II-2). （3） Hepatoprotective drugs Chinese association for the study of liver disease：uidelines for the diagnosis and management of alcoholic liver disease: Update 2010. Journal of Digestive Diseases 2011; 12; 45–50 （4） Detection and treatment of SAH Liver transplantation confers a survival benefit in patients with ALD classified as Child-Pugh C and/or MELD ≥15 (Recommendation A1) A 6-month period of abstinence before listing patients obviates u