糖皮质激素治疗肝衰竭及高胆红素血症患者的临床研究及安全性评价  

Study on the efficacy and safety of glucocorticoids in treating liver failure and hyperbilirubinemia

作　　者：张野[1] 聂青和[1] 

机构地区：[1]第四军医大学唐都医院全军感染病中心/传染病科,陕西西安710038

出　　处：《胃肠病学和肝病学杂志》2016年第5期510-512,共3页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探索应用糖皮质激素治疗肝衰竭或高胆红素血症患者的临床疗效及安全性。方法选取第四军医大学唐都医院2012年12月-2016年1月收治的76例急性/亚急性肝衰竭和高胆红素血症患者,其中对照组28例,给予常规内科综合治疗,治疗组48例,在常规内科综合治疗基础上给予糖皮质激素治疗(地塞米松10 mg,1次/d,2 d后减量至5 mg,1次/d,2 d,最后减量至2mg,1次/d,维持3 d),观察两组患者的临床疗效和并发症。结果两组患者治疗前血清总胆红素(TBil)、凝血酶原活动度(PTA)、白蛋白(ALB)水平差异无统计学意义(P>0.05);治疗1周后,治疗组TBil水平(228.3±97.2)μmol/L较对照组(276.4±73.2)μmol/L降低(P=0.001),PTA(44.3±12.9)%较对照组(39.9±18.3)%提高(P=0.017),但ALB水平两组比较差异无统计学意义[(32.2±2.3)g/L vs(33.9±7.8)g/L,P=0.184)];两组间各种并发症的发生率比较,差异无统计学意义(P>0.05);治疗组的救治成功率(60.4%)明显高于对照组(35.7%),差异有统计学意义(P=0.038)。结论糖皮质激素治疗可以提高急性/亚急性肝衰竭和高胆红素血症患者救治的成功率,在严格把握糖皮质激素适应证和治疗时机的前提下,其临床应用具有较好的安全性。Objective To observe the clinical efficacy and safety of glucocorticoids in treating liver failure and hyperbilirubinemia. Methods A total of 76 patients with acute/subacute liver failure or hyperbilirubinemia from Dec. 2012 to Jan. 2016 were analyzed. The patients were divided into two groups. Control group of 28 patients received integrated treatment, while treatment group of 48 patients received integrated treatment and glucocorticoids （Dexamethasone 10 mg/d i. v. for 2 days, and reduced to 5 mg/d i. v. for 2 days, and finally 2 mg/d i. v. for 3 days）. The clinical efficacy and complication were compared between two groups. Results There were no significant differences of TBil, PTA, and ALB between two groups before therapy （P 〉 0.05 ）. After one week therapy, TBil level was significantly lower in treatment group （228.3 ± 97.2） μmol/L than that in control group （276.4 ± 73.2） μmol/L （P = 0. 001 ）. Meanwhile, PTA was notably elevated in treatment group （44.3 ± 12.9）% than that in control group （39.9 ± 18.3）% （P =0. 017）. However, there was no remarkable difference in ALB level between two groups [ （32.2 ±2.3） g/L vs （33.9 ± 7.8） g/L, P = 0. 1841. The incidence of complications was similar between two groups （P 〉 0. 05）. The success rate corresponding to therapy was higher in treatment group （60.4%） than that in eontrol group （35.7% , P = 0. 038）. Conclusion Treatment with glucoeorticoids can improve the success rate in patients with aeute/subacute liver failure or hyperbilirubinemia. Clinical applieation of glucocortieoids is relatively safe with proper indications and treatment opportunity.

关 键 词：糖皮质激素 肝衰竭 高胆红素血症 治疗 

分 类 号：R575.3[医药卫生—消化系统]