小剂量糖皮质激素治疗HBV相关慢加急性肝衰竭的效果观察  

Efficacy of low-dose glucocorticoids in treatment of HBV-related acute-on-chronic liver failure

作　　者：邱波[1] 朱玲[1] 王堂明 严世春 张建明[1] 谢智安 刘星妤[1] 

机构地区：[1]攀枝花市疾病预防控制中心,攀枝花市第四人民医院肝病治疗中心,四川攀枝花617000

出　　处：《临床肝胆病杂志》2016年第7期1300-1304,共5页Journal of Clinical Hepatology

基　　金：四川省攀枝花市科学与技术产权局科研项目(2016CY-S-16-3)

摘　　要：目的探讨小剂量糖皮质激素治疗HBV相关慢加急性肝衰竭（HBV-ACLF）的疗效和安全性。方法收集2012年1月-2015年10月于攀枝花市第四人民医院肝病治疗中心诊治的HBV-ACLF患者118例。将纳入患者随机分为治疗组和对照组,每组各59例。所有患者均予以恩替卡韦抗病毒治疗和常规护肝、对症治疗,治疗组在此基础上加用小剂量氢化可的松琥珀酸钠（25 mg/d）静滴治疗。观察记录所有患者临床表现、肝功能生化指标、不良反应、住院时间及治疗费用情况等。计量资料组内比较采用配对t检验,组间比较采用t检验,计数资料组间比较采用χ^2检验或Fisher精确概率法。结果疗程结束时,治疗组患者肝功能生化指标（ALT、AST、TBil、白蛋白、胆碱酯酶、凝血酶原活动度）改善情况均好于对照组,差异均有统计学意义（P值均〈0.001）;治疗组患者住院天数[（48.0±9.2）d vs（74.0±16.4）d]及住院费用[（7974.5±853.7）元/人次vs（12 432.7±1263.1）元/人次]均低于对照组,差异均有统计学意义（t值分别为4.34、22.46,P值均〈0.01）;治疗组未发现氢化可的松琥珀酸钠的相关性不良反应。结论小剂量糖皮质激素氢化可的松琥珀酸钠用于治疗HBV-ACLF有明显消退黄疸、减轻病情、改善预后的疗效,并可缩短住院时间,减少住院费用,有较好的安全性,值得临床进一步探究。Objective To investigate the efficacy and safety of low- dose glucocorticoids in the treatment of HBV- related acute- on-chronic liver failure（ HBV- ACLF）. Methods A total of 118 patients with HBV- ACLF who were treated in Center for Liver Disease Treatment in the Fourth People＇s Hospital of Panzhihua from January 2012 to October 2015 were enrolled and randomly divided into treatment group and control group,with 59 patients in each group. All the patients were given antiviral therapy with entecavir and conventional liver-protecting and symptomatic treatment,and the patients in the treatment group were given intravenous drip of low- dose hydrocortisone sodium succinate（ 25 mg / d） in addition. The clinical manifestations,biochemical parameters for liver function,adverse events,length of hospital stay,and hospital costs were recorded for all patients. The t- test was used for comparison of continuous data between groups,the paired t- test was used for comparison of continuous data within groups,and the chi- square test or Fisher＇s exact test was used for comparison of categorical data between groups. Results At the end of the course of the treatment,the treatment group showed significantly better improvements in the biochemical parameters for liver function（ alanine aminotransferase,aspartate aminotransferase,total bilirubin,albumin,cholinesterase,and prothrombin activity） compared with the control group（ all P〈0. 001）. The treatment group had a significantly shorter length of hospital stay and significantly lower hospital costs than the control group（ length of hospital stay： 48. 0 ± 9. 2 d vs 74. 0 ± 16. 4 d,t = 4. 34,P〈0. 01; hospital costs： 7974. 5 ± 853. 7 RMB / person vs 12 432. 7 ± 1263. 1 RMB / person,t = 22. 46,P〈0. 01）. No patients in the treatment group experienced adverse events related to hydrocortisone sodium succinate. Conclusion In the treatment of HBV- ACLF,low- dose hydrocortisone sodium succinate can eliminate jaundice,alleviate conditions,and improve the pro

关 键 词：肝炎病毒 乙型 肝功能衰竭 糖皮质激素类 治疗 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]