控制两个特别的临床疾病可以有效预防肝硬化患者发生肝肾综合征：自发性细菌性腹膜炎（SBP）和酒精性肝炎。[5]Gines P, Guevara M, Arroyo V, et al. Hepatorenal syndrome. Lancet. 2003 Nov 29;362(9398):1819-27.http://www.ncbi.nlm.nih.gov/pubmed/14654322?tool=bestpractice.com
对于自发性细菌性腹膜炎患者，给予白蛋白和抗菌治疗可以减少肾脏损伤和死亡率。[6]Sort P, Navasa M, Arroyo V, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999 Aug 5;341(6):403-9.http://content.nejm.org/cgi/content/full/341/6/403http://www.ncbi.nlm.nih.gov/pubmed/10432325?tool=bestpractice.com[7]Wong F, Blendis L. New challenge of hepatorenal syndrome: prevention and treatment. Hepatology. 2001 Dec;34(6):1242-51.https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1053/jhep.2001.29200http://www.ncbi.nlm.nih.gov/pubmed/11732014?tool=bestpractice.com
美国胃肠病学会 (The American College of Gastroenterology) 推荐患有严重酒精性肝炎的患者应使用皮质类固醇进行治疗（假设无禁忌证）。[8]Singal AK, Bataller R, Ahn J, et al. ACG clinical guideline: alcoholic Liver Disease. Am J Gastroenterol. 2018 Feb;113(2):175-94.http://www.ncbi.nlm.nih.gov/pubmed/29336434?tool=bestpractice.com 在一项随机对照临床试验中，泼尼松龙显著降低了 28 天死亡率，但增加了感染风险。[9]Thursz MR, Richardson P, Allison M, et al. Prednisolone or pentoxifylline for alcoholic hepatitis. N Engl J Med. 2015 Apr 23;372(17):1619-28.https://www.nejm.org/doi/10.1056/NEJMoa1412278?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.govhttp://www.ncbi.nlm.nih.gov/pubmed/25901427?tool=bestpractice.com 在随后的一项 meta 分析中，糖皮质激素并未降低酒精性肝炎患者的全因死亡率。[10]Pavlov CS, Varganova DL, Casazza G, et al. Glucocorticosteroids for people with alcoholic hepatitis. Cochrane Database Syst Rev. 2017 Nov 2;(11):CD001511.https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001511.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/29096421?tool=bestpractice.com
己酮可可碱并未改善酒精性肝炎患者的生存率，[9]Thursz MR, Richardson P, Allison M, et al. Prednisolone or pentoxifylline for alcoholic hepatitis. N Engl J Med. 2015 Apr 23;372(17):1619-28.https://www.nejm.org/doi/10.1056/NEJMoa1412278?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.govhttp://www.ncbi.nlm.nih.gov/pubmed/25901427?tool=bestpractice.com 不推荐使用。[8]Singal AK, Bataller R, Ahn J, et al. ACG clinical guideline: alcoholic Liver Disease. Am J Gastroenterol. 2018 Feb;113(2):175-94.http://www.ncbi.nlm.nih.gov/pubmed/29336434?tool=bestpractice.com
