小剂量糖皮质激素短程治疗慢性乙型肝炎重型倾向的近期疗效  

The short-term efficacy of small dosage of dexamethasone therapy in chronic hepatitis B with tendency to severe hepatitis

作　　者：杨波[1] 吴元凯[2] 吴宗华[3] 谢伟东[4] 许珏[3] 高志良[2] 陈禄彪[2] 谢仕斌[2] 田德英[5] 

机构地区：[1]武钢二医院感染科 [2]中山大学附属第三医院传染病学教研室, 广州,510630 [3]中山大学附属第三医院检验科, 广州,510630 [4]515200,广东省惠来县人民医院感染科 [5]华中科技大学附属同济医院传染病学教研室, 武汉,430030

出　　处：《国际流行病学传染病学杂志》2013年第3期-,共5页International Journal of Epidemiology and Infectious Disease

摘　　要：目的 观察小剂量糖皮质激素短程冲击治疗慢性乙型肝炎重型倾向患者的近期疗效.方法 将中山大学附属第三医院感染科2010年7月至2011年11月收治的60例慢性乙型肝炎重型倾向患者分为治疗组30例和对照组30例,两组均给予内科综合治疗及恩替卡韦抗病毒治疗;治疗组在上述治疗基础上加用地塞米松10mg/次,静脉推注1次/d,治疗3d.检测并比较第0、1、2、4、8、10和12周患者ALT、TBil、血清凝血酶原时间(PT),比较两组治愈好转率及住院天数.结果 入院时治疗组和对照组的的ALT水平分别为(561.6±425.1)和(576.8±437.8) U/L,两组差异无统计学意义(t=-0.36,P＞0.05),治疗后两组ALT均随时间呈下降趋势,自人院第1周起,在以后各周的检测中治疗组ALT均低于对照组,但第12周时治疗组和对照组的ALT水平分别为(38.9±10.9)和(40.6±11.3) U/L,差异无统计学意义(t=-0.13,P＞0.05).治疗组TBil水平在治疗后第1、2、4、8、10和12周分别为(449.2±185.3)、(350.1±194.8)、(235.6±91.6)、(189.6±64.7)、(120.8±56.9)和(74.6±32.8) μmol/L,均低于对照组(t=-7.20、-12.97、-17.52、-14.80、-11.60和-10.71,P＜0.05),PT 水平在治疗后第1、2、4、8、10和12周分别为(40.2±6.7)、(30.3±10.6)、(27.3±5.9)、(22.3±6.4)、(19.4±6.5)和(17.3±7.5)s,均高于对照组(t=-6.05、-6.68、-8.48、-10.28、-6.60和-4.69,P＜0.05).治疗组的治愈好转率86.7％(26/30)明显高于对照组的43.3％(13/30)(x2=0.02,P＜0.05),平均住院时间32.1 d,短于对照组79.7 d(t=-17.27,P＜0.05).结论 在内科治疗基础上使用小剂量激素治疗慢性乙型肝炎重型倾向患者能更快有效改善肝功能及凝血功能,提高治愈好转率,缩短住院时间.Objective To evaluate the efficacy of small dosage dexamethasone therapy in chronic viral hepatitis B patients with tendency to severe hepatitis.Methods Sixty cases of chronic hepatitis B patients with tendency to severe hepatitis in the Third Affiliated Hospital of Sun Yat-sen University from July 2010 to November 2011 were randomly divided into the treatment group (n =30) and control group (n =30).The control group received comprehensive physical treatment and antiviral treatment with entecavir,while the treatment group was treated with dexamethasone therapy (10 mg/d,3 days,intravenous injection) on the basis of the above mentioned treatment.The serum alanine transaminase (ALT),total bilirubine (TBil),prothrombin time (PT),clinical improvement rate and hospitalization time between the two groups were compared during therapy at weeks 0,1,4,8,10 and 12.Results The serum ALT levels on admission were (561.6 ± 425.1) and (576.8 ± 437.8) U/L respectively.There were no significant statistical differences between the two groups(t =-0.36,P ＞ 0.05).After the treatment,ALT levels in two groups decreased with time.ALT in treatment group were all lower than control group from week 1 to week 10.However,at week 12,the serum ALT levels in 2 groups were(38.9 ± 10.9) and (40.6 ± 11.3) U/L respectively.There were no significant statistical differences between the two groups(t =-0.13,P ＞ 0.05).Compared to the control group,TBil decreased and PT shortened significantly in treatment group patients after therapy for 12 weeks.The serum TBil in treatment group at weeks 1,2,4,8,10 and 12 were (449.2± 185.3),(350.1 ± 194.8),(235.6±91.6),(189.6±64.7),(120.8± 56.9) and (74.6± 32.8) μmol/L,and were lower than control group (t =-7.20,-12.97,-17.52,-14.80,-11.60 and-10.71,P ＜ 0.05).The PT in treatment group at weeks 1,2,4,8,10 and 12 were(40.2 ± 6.7),(30.3 ± 10.6),(27.3 ± 5.9),(22.3 ± 6.4),(19.4 ± 6.5)and (17.3 ± 7.5)s,and were higher than control group (t =-6.05,-6.68,-8.48,-10.28,-6.60 and-4.69,P ＜0.05).The improvem

关 键 词：肝炎 乙型 重型肝炎 糖皮质激素 

分 类 号：R512.62[医药卫生—内科学]