アルコール性肝障害(アルコール関連肝疾患)診療ガイド 2022

出版社: 文光堂
著者:
発行日: 2022-10-16
分野: 臨床医学:内科  >  肝/胆/膵
ISBN: 9784830621130
電子書籍版: 2022-10-16 (第1版第1刷)
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日本肝臓学会編集によるアルコールによる臓器障害を取り上げた初の診療ガイドブック.日本における1日平均アルコール摂取量60g以上の多量飲酒者は約860万人と推測されており,アルコール性肝障害(アルコール関連肝疾患)による死亡者数は増加傾向にある.本書ではアルコール性肝障害の疫学,病態生理,診断に関する最新のエビデンス,生活指導から薬物療法に至るマネジメント・治療の実際までを網羅して取り上げ,エキスパートオピニオンとして実践的に解説した.診療で必要な知識やスキルの具体的なポイントをまとめた,全臨床医必携の一冊.

目次

  • 第1章 疾患概念
     1. アルコールによる健康被害と肝障害
     2. アルコール依存症とアルコール使用障害─その概念と診断
     [1]アルコール依存症の概念
     [2]アルコール依存症の診断
     [3]アルコール依存症とアルコール使用障害の概念の相違と問題点
     3. わが国におけるアルコール性肝障害(ALD)の診断基準─その変遷と現状
     4. ALDの病型分類と進展様式
     5. 重症アルコール性肝炎の問題
     6. ALDの概念の国際動向
     7. ALDと非アルコール性脂肪性肝疾患(NAFLD)
     8. 飲酒量低減治療とハームリダクション

    第2章 疫学的側面
     1. わが国のアルコール消費の実態
     2. わが国のアルコール使用障害の実態
     3. アルコール性肝障害(ALD)の国際的動向とわが国における実態
     4. ALDの予後

    第3章 病態生理
     1. 概論
     2. 肝細胞障害機序
     [1]肝細胞におけるエタノール代謝とミトコンドリア障害
     [2]酸化ストレスや小胞体(ER)ストレスを介した肝細胞死
     [3]腸内細菌叢の肝細胞障害への関与
     [4]肝微小循環障害の肝細胞障害への関与
     3. 肝細胞内脂肪滴貯留機序
     4. 肝線維化進展機序
     5. 肝発癌機序
     6. 炎症による他臓器を介した肝臓との連関
     7. アルコール性肝障害(ALD)と性差

    第4章 診断
     1. 病理診断(肝生検)
     [1]肝生検
     [2]病理所見
     2. 臨床診断(バイオマーカー・非侵襲的診断の活用)
     [1]飲酒マーカー
     [2]肝線維化マーカー
     [3]重症度スコア

    第5章 マネジメント・治療
     1. 脂肪肝・脂肪肝炎への対応
     [1]代謝異常の頻度
     [2]肥満
     [3]糖尿病
     2. 重症アルコール性肝炎,acute-on-chronic liver failure(ACLF)の治療
     [1]治療の概要
     [2]内科的治療の各論
     [3]全国集計からみた治療の実態
     3. アルコール性肝硬変のマネジメント
     [1]栄養サポート
     [2]合併症対策
     4. アルコール性肝癌の対策
     5. 非代償性肝硬変,アルコール性肝炎/ACLF,肝細胞癌合併例に対する肝移植
     [1]アルコール性の非代償性肝硬変
     [2]重症アルコール性肝炎/ACLF
     [3]肝細胞癌合併例
     6. 臓器障害に対する断酒と飲酒量低減治療
     [1]アルコール関連臓器障害に対する断酒
     [2]アルコール関連臓器障害に対する飲酒量低減治療

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