泼尼松对重症酒精性肝炎患者病死率的影响  

Effect of prednisolone on the mortality of patients with severe alcoholic hepatitis

作　　者：董娟 郭红梅[1] 徐杰 

机构地区：[1]新疆医科大学附属中医院消化科,乌鲁木齐市830000

出　　处：《临床合理用药杂志》2018年第4期38-39,41,共3页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的观察泼尼松治疗重症酒精性肝炎患者对28 d后短期及中期病死率的影响。方法收集2010年1月-2014年6月在医院住院并临床确诊为重症酒精性肝炎患者273例,随机分为泼尼松治疗组135例及安慰剂对照组138例,2组患者均接受同等程度常规支持治疗及营养补充,泼尼松治疗组患者予泼尼松40mg/d口服,而安慰剂治疗组接受安慰剂口服,2组疗程均为28 d,随访时间为1年。比较2组患者28 d治疗结束时病死率、90 d病死率及1年病死率。观察2组不良反应发生情况。结果泼尼松治疗组患者28d的病死率低于安慰剂对照组,差异均有统计学意义(P<0.05)。2组治疗90d及1年的病死率比较差异均无统计学意义(P>0.05)。2组上消化道出血、腹水、肝功能衰竭及肾功能不全等不良反应发生率比较差异均无统计学意义(P>0.05)。泼尼松治疗组感染的发生率高于安慰剂对照组,差异有统计学意义(P<0.05)。结论泼尼松治疗重症酒精性肝炎可显著降低28 d病死率,对于90 d及1年病死率泼尼松治疗显著增加了患者感染的风险,但不影响病死率。Objective To observe the effect of prednisone on the short-term and medium-term mortality of patients with severe alcoholic hepatitis after 28 days. Methods Collected clinically diagnosed severe alcoholic hepatitis patients 273 cases from January 2010 to June 2014 in the hospital. Patients were randomly divided into prednisone treatment group 135 cases and placebo control group 138 cases. Prednisone treatment group received 40 mg/d of oral prednisolone while placebo control group received oral placebo tablet that looks similar to prednisolone. Both groups were treated for 28 days and followed up for 1 year. The 28 day mortality,90 day mortality and 1 year mortality in two groups was compared. Two groups of adverse reactions were observed. Results Prednisone treatment group 28 d mortality was lower than placebo control group,the difference was statistically significant（ P 0. 05）. There was no significant difference in mortality between two groups at 90 and 1 years（ P 0. 05）. There was no significant difference in incidence of adverse reactions between two groups,such as upper gastrointestinal bleeding,ascites,liver failure and renal insufficiency（ P 0. 05）. The incidence of infection in prednisone treatment group was higher than placebo control group,the difference was statistically significant（ P 0. 05）. Conclusion Prednisolone in treatment of severe alcoholic hepatitis for 28 days significantly reduced mortality compared to placebo group. But it had no effect on 90 day and 1 year mortality. Prednisolone group had significantly higher incidence of infection,but did not affect mortality rate.

关 键 词：重症酒精性肝病 泼尼松 治疗 安全性 

分 类 号：R575.1[医药卫生—消化系统]