糖皮质激素治疗重症酒精性肝炎的疗效评价  

Valuation of curative effect on glucocorticoid in severe alcoholic hepatitis

作　　者：潘林林[1] 彭蕾[1] 周学士[1] 甘建和[1] 赵卫峰[1] 

机构地区：[1]苏州大学附属第一医院感染病科,215006

出　　处：《国际消化病杂志》2012年第3期180-183,共4页International Journal of Digestive Diseases

基　　金：十二五艾滋病和病毒性肝炎等传染病防治科技重大专项(2012X10002004008)

摘　　要：目的评价糖皮质激素治疗重症酒精性肝炎(SAH)的疗效和预后。方法回顾性分析2007年1月至2011年1月期间接受治疗的30例SAH患者,随机分为治疗组和对照组各15例。对照组予戒酒、纠正营养不良及常规内科综合治疗;治疗组予上述治疗的同时,每日给予甲基强的松龙(1 mg/Kg),定期减量,疗程为28 d。检测两组患者治疗基线、治疗7 d和28 d后的肝功能、肾功能、凝血功能,评估基线马德里判别函数(MDF)评分和终末期肝病模型(MELD)评分等,比较两组生存率和并发症发生率。结果治疗28 d后治疗组总胆红素、凝血酶原时间、血清白蛋白分别为(39.48±15.41)mol/L、(12.96±1.56)s、(39.23±5.86)g/L,分别优于对照组的(76.89±36.34)mol/L、(17.49±4.34)s、(32.36±3.82)g/L,两组间差异有统计学意义(P<0.01)。治疗组的28 d生存率和并发症发生率分别为86.67%、13.33%,对照组分别为53.33%、46.67%,两组间差异有统计学意义(P<0.05)。影响预后的因素为肝功能、MELD评分和总胆红素水平早期(治疗7 d)变化(ECBL)。结论采用糖皮质激素治疗SAH,能明显改善肝功能、提高28 d生存率、减少并发症发生率。Objective To evaluate the curative effect on glucocorticoid in severe alcoholic hepatitis and prognosis. Methods Thirty patients with severe alcoholic hepatitis were selected, who were treated from January 2007 to January 2011, and a retrospective analysis was performe. Patients were divided into 2 groups. The control group （15 cases）, who were treated with quit drinking, correct malnutrition and general medical treatment. The treatment group （15 cases）, who were treated with methyl-prednisone （1 mg/kg） every day on the basis treatment of the control group. Periodic reduction, the two groups were treated for 28 days. The liver function, kidney function, blood coagulation of the two groups in baseline, on 7th and 28th day were detected. The MDF scores and MELD scores of the patients of the two groups in baseline were calculated. The survival rate and complications of the two groups were estimated. Results After 28 days, the levels of the total bilirubin, prothrombin time and serum albumin in patients of treatment group were （39.48± 15.41） mol/L, （12.96 ± 1.56） s, （39.23 ± 5.86） g/L. The levels in control group were （76. 89 ± 36.34） mol/L, （17.49 ± 4.34） s, （32.36 ± 3. 82） g/L. There were significant differences between the two groups （P〈0.01）. The survival rate was 86.67% in treatment group, and 53.33% in control group （P〈0.05） at the 28th day. The complication was 13.33% in treatment group, and 46.7% in control group （P〈0.05）. The factors affecting the prognosis were liver function, MELD score and early change （7 d） in bilirubin levels （ECBL）. Conclusion The therapeutic effectiveness of glucocorticoid is that it can improve liver function of severe alcoholic hepatitis patients and improve survival rate, as well as reduced the complications.

关 键 词：糖皮质激素 重症酒精性肝炎 疗效 预后 

分 类 号：R575.1[医药卫生—消化系统]