巴氯芬
初步研究表明,γ-氨基丁酸 B 型(GABA-B)受体激动剂巴氯芬减少酒精依赖患者的嗜酒和酒精摄入并改善戒酒。[99]Flannery BA, Garbutt JC, Cody MW, et al. Baclofen for alcohol dependence: a preliminary open-label study. Alcohol Clin Exp Res. 2004;28:1517-1523.http://www.ncbi.nlm.nih.gov/pubmed/15597084?tool=bestpractice.com[100]Addolorato G, Leggio L, Ferrulli A, et al. Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study. Lancet. 2007;370:1915-1922.http://www.ncbi.nlm.nih.gov/pubmed/18068515?tool=bestpractice.com[101]Leggio L, Kenna GA, Swift RM. New developments for the pharmacological treatment of alcohol withdrawal syndrome. A focus on non-benzodiazepine GABAergic medications. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32:1106-1117.http://www.ncbi.nlm.nih.gov/pubmed/18029075?tool=bestpractice.com 巴氯芬治疗酒精中毒或神经功能障碍患者没有明显不良反应的报道。[102]Addolorato G, Leggio L, Agabio R, et al. Baclofen: a new drug for the treatment of alcohol dependence. Int J Clin Pract. 2006;60:1003-1008.http://www.ncbi.nlm.nih.gov/pubmed/16893442?tool=bestpractice.com 在RCT,已发现巴氯芬减少酒精摄入和渴求,促进戒酒。[100]Addolorato G, Leggio L, Ferrulli A, et al. Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study. Lancet. 2007;370:1915-1922.http://www.ncbi.nlm.nih.gov/pubmed/18068515?tool=bestpractice.com 针对巴氯芬治疗酒精依赖肝硬化者的测试发现其改善了几个肝功能参数。巴氯芬可能成为肝脏病学家治疗酒精依赖患者的一个重要工具。[103]Gache P, Hadengue A. Baclofen improves abstinence in alcoholic cirrhosis: Still better to come? J Hepatol. 2008;49:1083-1085.http://www.ncbi.nlm.nih.gov/pubmed/18930331?tool=bestpractice.com
S-腺苷蛋氨酸或甜菜碱
S-腺苷同型半胱氨酸(SAH)浓度在喂食酒精的动物肝细胞中升高。添加 S-腺苷蛋氨酸(SAM)或甜菜碱可降低升高的 SAH 毒性和同型半胱氨酸水平。[104]Barak AJ, Beckenhauer HC, Mailliard ME, et al. Betaine lowers elevated s-adenosylhomocysteine levels in hepatocytes from ethanol-fed rats. J Nutr. 2003;133:2845-2848.http://jn.nutrition.org/content/133/9/2845.fullhttp://www.ncbi.nlm.nih.gov/pubmed/12949375?tool=bestpractice.com 在动物研究中,SAM 已显示出明显改善肝病的结果。
水飞蓟素
水飞蓟素(乳蓟的活性成分)有抗氧化作用,防止脂质过氧化,具有抗炎和抗纤维化作用。[105]Hanje AJ, Fortune B, Song M, et al. The use of selected nutrition supplements and complementary and alternative medicine in liver disease. Nutr Clin Pract. 2006;21:255-272.http://www.ncbi.nlm.nih.gov/pubmed/16772543?tool=bestpractice.com 已经观察到对肝病患者有益,特别是酒精性肝硬化患者和那些疾病较轻的患者。[106]Ferenci P, Dragosics B, Dittrich H, et al. Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver. J Hepatol. 1989;9:105-113.http://www.ncbi.nlm.nih.gov/pubmed/2671116?tool=bestpractice.com 随后的随机对照试验显示水飞蓟素对酒精性肝硬化患者总体死亡率和临床病程无影响。[107]Parés A, Planas R, Torres M, et al. Effects of silymarin in alcoholic patients with cirrhosis of the liver: results of a controlled, double-blind, randomized and multicenter trial. J Hepatol. 1998;28:615-621.http://www.ncbi.nlm.nih.gov/pubmed/9566830?tool=bestpractice.com 水飞蓟素对酒精性肝病的有益效果的临床试验已有多种结果。[108]Saller R, Brignoli R, Melzer J, et al. An updated systematic review with meta-analysis for the clinical evidence of silymarin. Forsch Komplementmed. 2008;15:9-20.http://www.ncbi.nlm.nih.gov/pubmed/18334810?tool=bestpractice.com 目前,没有明确的证据推荐在酒精性肝病使用本剂。
美他多辛
美他多辛在欧洲可用但在美国不可用,是一种加速酒精清除及减少酒精渴求和消费的药物。[109]Leggio L, Kenna GA, Ferrulli A, et al. Preliminary findings on the use of metadoxine for the treatment of alcohol dependence and alcoholic liver disease. Hum Psychopharmacol. 2011;26:554-559.http://www.ncbi.nlm.nih.gov/pubmed/22095793?tool=bestpractice.com 到目前为止,研究已经表明口服美他多辛对保持戒酒以及持续饮酒的酒精性肝病患者有可喜的结果。