糖皮质激素治疗酒精性肝炎的初步尝试  

Initial attempt of glucocorticoids treatment for alcoholic hepatitis

作　　者：陈星均 木尼热·阿地力江 阿迪莱·麦麦提伊敏 王炳元[3] 张永萍[2] Chen Xingjun;Munire Adilijiang;Adilai Maimaitiyimin;Wang Bingyuan;Zhang Yongping(Xinjiang Medical University,Urumqi 830054,Xinjiang,China;Department of Infectious Diseases,People’s Hospital of Xinjiang Uygur Autonomous Region,Urumqi,830001,Xinjiang,China;Department of Gastroenterology,The First Affiliated Hospital of China Medical University,Shenyang 110001,Liaoning Province,China)

机构地区：[1]新疆医科大学,新疆乌鲁木齐830054 [2]新疆维吾尔自治区人民医院感染性疾病科,新疆乌鲁木齐830001 [3]中国医科大学附属第一医院消化内科,辽宁沈阳110001

出　　处：《中国肝脏病杂志（电子版）》2023年第4期54-60,共7页Chinese Journal of Liver Diseases：Electronic Version

基　　金：新疆维吾尔自治区自然科学基金(2021D01C153)。

摘　　要：目的 观察糖皮质激素(glucocorticoids,GC)治疗酒精性肝炎(alcoholic hepatitis,AH)的临床疗效。方法 回顾性分析2019年1月至2023年3月新疆维吾尔自治区人民医院收治的44例AH患者的临床资料,根据治疗方案是否使用GC治疗分为GC组(16例)及非GC组(28例)。收集的指标包括丙氨酸氨基转移酶(alanine transaminase,ALT)、天门冬氨酸氨基转移酶(aspartate amino transferase,AST)、总胆红素(total bilirubin,TBil)、国际标准化比值(international normalized ratio,INR)、白蛋白(albumin,ALB)、球蛋白(globulin,GLO)、γ-谷氨酰转肽酶(gamma-glutamyltransferase,GGT)、白细胞计数(white blood cell count,WBC)、中性粒细胞比例(neutrophil ratio,NEUT)、血小板计数(platelet count,PLT)、平均红细胞体积(mean corpuscular volume,MCV)、肌酐(creatinine,Cr)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶原时间(prothrombin time,PT)、凝血酶原活动度(prothrombintime activity,PTA),计算MELD评分、Maddrey判别函数(maddrey’s discriminant function,m DF),计算GC组与非GC组28 d、90 d和180 d存活率,观察GC组治疗0 d、3 d、7 d的临床指标变化,并分析合并感染的AH患者使用GC治疗是否影响短期预后。结果 (1)GC组患者年龄小于非GC组[(46.63±7.98)岁vs (54.89±11.40)岁],基线TBil(中位数:300.04μmol/L vs 101.72μmol/L)、GGT(中位数:305.50 U/L vs 96.00 U/L)、WBC[(14.45±8.69)×10^(9)/L vs (8.67±4.58)×10^(9)/L]、NEUT(中位数:6.87×10^(9)/L vs 9.36×10^(9)/L)、MCV [(106.09±8.85)fL vs(99.43±9.45)fL]均高于非GC组患者,INR(1.62±0.35 vs 2.04±0.91)和PT [(19.01±3.39)s vs(22.63±7.63)s]低于非GC组患者,差异均有统计学意义(P均<0.05)。(2)GC组患者90 d生存率显著高于非GC组[81.3%(13/16)vs 46.4%(13/28);χ^(2)=1.182,P=0.024],GC组和非GC组患者28 d生存率分别为93.7%(15/16)、64.3%(18/28),差异无统计学意义(χ^(2)=3.274,P=0.070),GC组和非GC组患者180 d生存率分别为56.3%(9/16)、39.3%(Objective To observe the clinical efficacy of glucocorticoids(GC)in the treatment of alcoholic hepatitis(AH).Methods The clinical data of 44 patients with AH in the People’s Hospital of Xinjiang Uygur Autonomous Region from January 2019 to March 2023 were retrospectively analyzed and divided into GC group(16 cases)and non-GC group(28 cases)according to the treatment plan.The levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),international normalized ratio(INR),albumin(ALB),globulin(GLO),gamma glutamyltransferase(GGT),white blood cell count(WBC),neutrophil ratio(NEUT),platelet count(PLT),mean corpuscular volume(MCV),creatinine(Cr),activated partial thromboplastin time(APTT),prothrombin time(PT)and prothrombin activity(PTA)were recorded.MELD score and Madrey’s discriminant function(mDF)were calculated.The survival rates of patients in GC group and non-GC group at 28 d,90 d and 180 d were calculated,and the changes of clinical indexes in GC group at 0 d,3 d and 7 d were observed.Whether the use of GC treatment in AH patients with co-infection affected the short-term prognosis were analyzed.Results①Patients in GC group were younger than those in non-GC group[(46.63±7.98)years vs(54.89±11.40)years],the baseline level of TBil(median:300.04μmol/L vs 101.72μmol/L),GGT(median:305.50 U/L vs 96.00 U/L),WBC[(14.45±8.69)×10^(9)/L vs(8.67±4.58)×10^(9)/L],NEUT(median:6.87×10^(9)/L vs 9.36×10^(9)/L)and MCV[(106.09±8.85)fL vs(99.43±9.45)fL]of patients in GC group were higher than those in non-GC group,the baseline level of INR(1.62±0.35 vs 2.04±0.91)and PT[(19.01±3.39)s vs(22.63±7.63)s]were lower than those in non-GC group,the differences were statistically significant(all P<0.05).②The 90 d survival rate of patients in GC group was significantly higher than that of non-GC group[81.3%(13/16)vs 46.4%(13/28);χ^(2)=1.182,P=0.024].The 28 d survival rate of patients in GC group and non-GC group were 93.7%(15/16)and 64.3%(18/28),respectively,the differences were not sta

关 键 词：糖皮质激素 酒精性肝炎 临床疗效 

分 类 号：R575.1[医药卫生—消化系统]