胆道闭锁术后大剂量类固醇的疗效及安全性

Effect and safety of high-dose steroids in postoperative treatment of biliary atresia

目的探讨胆道闭锁Kasai术后大剂量类固醇应用的有效性和安全性。方法回顾分析复旦大学附属儿科医院1997年1月～2003年10月胆道闭锁术后52例患儿药物治疗方法及随访资料，比较地塞米松短期冲击治疗（A组）与大剂量甲基强的松龙长期用药（B组）在自体肝生存率、胆汁清除情况，反流性胆管炎发生率及激素并发症等方面的差异。结果平均（32±3．23）个月的随访期内，患儿自体肝总生存率为71．14％。A组自体肝1年生存率为74．75％，2年生存率为68．52％，B组自体肝1年生存率84．97％，2年生存率为67．97％，两组生存率曲线差异无显著性意义（P〉0．05）。两组患儿术后6个月黄疸清除率分别为44．0％（11／25）和74．48％（20／27），差异有显著性意义（P〈0．05）。A组术后胆管炎发生率为56．0％（14／25），B组为25．92％（7／27）（P〈0．05）。B组中1例患儿术后1个月激素治疗疗程中出现消化道出血。结论较短期冲击治疗相比，大剂量长期使用类固醇（甲基强的松龙）可以改善胆道闭锁患儿的术后近期的胆汁引流，减少胆管炎的发生率，但并不能延长自体肝的生存年限。激素使用过程中的并发症的存在影响着其安全性，尚需进一步观察和评价。

Objective To evaluate the efficacy and safety of high-dose steroids in the treatment of biliary atresia after Kasai procedure. Methods We reviewed 52 patients with biliary atresia who underwent operations between Jan, 1997 to Oct, 2003. The patients were separated into two groups： Patients in Group A were treated with short-term pulsed dexamethasone （1 mg·kg^-1 ·d^-1 for at least 3 days）, while patients in group B were treated with methylprednisolone （4 mg·kg^-1·d ^-1 ） for 18 to 30 weeks. We compared the rates of jaundice, survival rates of the native liver, and the occurrence of cholangitis between the two groups, We also analyzed the steroid-related complications. Results There was no obvious difference between the survival rates two years post-operatively. Six months after operation, the rate of jaundice clearance was 44. 0% in group A, while it was 74. 48% in group B （P〈0.05）. The occurrence of cholangitis in group A was 56.0%, while it was 25.92% in group B respectively （P〈0. 05）. Gastrointestinal bleeding was observed in one patient in group B, one month after operation. Conclusions These data implied that long-term high-dose steroid therapy may promote the bile flow and reduce the rate of cholangitis, but it cannot obviate early liver transplantation. Further investigation of the safety of long-term steroid therapy is needed.