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Review Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2025 Jun 13:S1542-3565(25)00493-8. doi: 10.1016/j.cgh.2025.05.016 Q112.02025

Pharmacological Strategies for the Management of Severe Alcohol-associated Hepatitis: A Systematic Review and Meta-analysis

严重酒精性肝炎的药理学策略：系统评价和 meta 分析 翻译改进

Alvi H Islam  1, Claudia Alvizuri  2, Hailemichael Desalegn  3, Emily Stephenson  1, Francisco Idalsoaga  4, Luis Antonio Diaz  5, John K MacDonald  6, Gene Y Im  7, Ashwani K Singal  8, Vipul Jairath  9, Mohammad Qasim Khan  10, Juan Pablo Arab  11

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作者单位

  • 1 Division of Gastroenterology, Department of Medicine, Western University, London Health Sciences Center, London, Ontario, Canada.
  • 2 Department of Gastroenterology, Cayetano Heredia National Hospital, Lima, Peru.
  • 3 Alimentiv, London, Ontario, Canada; Toronto Centre for Liver Disease (TCLD), University of Toronto, Toronto, Ontario Canada.
  • 4 Division of Gastroenterology, Department of Medicine, Western University, London Health Sciences Center, London, Ontario, Canada; Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
  • 5 Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; MASLD Research Center, Division of Gastroenterology and Hepatology, University of California San Diego, San Diego, California, USA.
  • 6 Alimentiv, London, Ontario, Canada.
  • 7 Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
  • 8 Department of Medicine, Division of Gastroenterology Hepatology and Nutrition, University of Louisville, Louisville, KY, USA.
  • 9 Division of Gastroenterology, Department of Medicine, Western University, London Health Sciences Center, London, Ontario, Canada; Alimentiv, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
  • 10 Division of Gastroenterology, Department of Medicine, Western University, London Health Sciences Center, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
  • 11 Alimentiv, London, Ontario, Canada; Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA. Electronic address: juanpablo.arab@vcuhealth.org.

    • DOI: 10.1016/j.cgh.2025.05.016 PMID: 40518060

    摘要 中英对照阅读

    Background: Alcohol-associated hepatitis (AH) is a severe form of alcohol-associated liver disease, with a short-term mortality of up to 50% within three months. The aim of this systematic review was to determine the optimal pharmacological treatment for severe AH that results in better survival outcomes. Methods: MEDLINE, EMBASE and CENTRAL... ...点击完成人机验证后继续浏览

    背景: 酒精性肝炎（AH）是一种严重的酒精相关性肝病，患者在三个月内的短期死亡率可高达50%。本系统综述的目的是确定对于严重AH的最佳药物治疗方案，以改善生存结果。

    方法: MEDLINE、EMBASE和CENTRAL数据库至2025年2月16日被搜索，用于筛选成人严重AH患者的随机对照试验（RCTs）。主要结局指标是28天死亡率。次要结局包括90天内死亡率、不良事件的发生率、肝肾综合征、急性肾损伤或感染以及肝脏移植的比率。每个结果计算了合并的风险比（RR）和95%置信区间（CI），并使用GRADE方法评估证据确定性。

    结果: 综述中包括了52项随机对照试验，共有5,121名参与者。与安慰剂相比，皮质类固醇在28天内观察到了生存优势（RR=0.62，95% CI 0.41-0.95）；皮质类固醇加N-乙酰半胱氨酸与单独使用皮质类固醇相比（RR=0.35，95% CI 0.16-0.78），粒细胞集落刺激因子联合五羟色林与单用五羟色林相比（RR=0.27，95% CI 0.13-0.54），以及甲硫氨酸加考片联合皮质类固醇相对于单独使用皮质类固醇（RR=0.47，95% CI 0.25-0.90）或五羟色林（RR=0.50，95% CI 0.26-0.96）均观察到了生存优势。证据的确定性范围从非常低到中等。

    结论: 皮质类固醇作为符合条件患者的一线治疗药物的有效性得到了较低程度确证的支持。其他疗法支持的证据确定性则从中等到极低不等，需要进一步研究来确认这些益处。

    关键词: 荟萃分析；系统综述；酒精；酒精性肝炎；AH管理。

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    期刊名：Clinical gastroenterology and hepatology

    缩写：CLIN GASTROENTEROL H

    ISSN：1542-3565

    e-ISSN：1542-7714

    IF/分区：12.0/Q1

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