抗病毒基础上应用糖皮质激素治疗慢性重型乙型肝炎临床分析

Effects of glucocorticoids combined with antiviral therapy in treatment of patients with chronic severe hepatitis B.

目的评价在抗病毒治疗的基础上应用糖皮质激素治疗早期慢性重型乙型肝炎的临床疗效。方法选取63例早期慢性重型乙型肝炎患者,随机分为治疗组33例,对照组30例,其中治疗组在综合治疗的基础上应用拉米夫定或恩替卡韦抗病毒及地塞米松等糖皮质激素治疗。对照组30例采用拉米夫定或恩替卡韦抗病毒及常规综合治疗。观察两组治疗前后的临床症状、血清总胆红素、凝血酶原活动度、HBVDNA及并发症等情况。结果8周后与对照组比较,治疗组患者血清总胆红素明显降低(P<0.05),凝血酶原活动度提升幅度大(P<0.05),肝性脑病、肝肾综合征等并发症减少(P<0.05),临床症状明显好转。4周后血清PCRHBVDNA阴转率为87.1%与对照组的85.1%相比,差异无统计学意义(P>0.05),治疗组的治疗失败率为15.2%(5/33)明显低于对照组的40.0%(12/30)(P<0.05)。结论在抗病毒治疗的基础上应用糖皮质激素对早期慢性重型乙型肝炎疗效显著,安全性好。

Objective To evaluate the clinical efficacy of glucocorticoids combined with antiviral therapy in the treatment of patients with early stage of chronic severe hepatitis B. Methods 63 patients with early stage of chronic severe hepatitis B were enrolled. 33 patients in treatment group received the ordinary treatment plus dexamethasone and lamivudine/entecavir. The changes of clinical symptoms, the serum total bilirubin （TBil）, the prothrombin activities （PTA） and the serum HBVDNA levels in the 2 groups were observed before and after therapy. The side effect and complication of each group were monitored. Results After 8 weeks treatment, compared with control group, the treatment group can significantly de- crease the level of TBil （ P 〈 0. 05 ）, increase PTA level （ P 〈 0. 05 ）, and improve the clinical symptoms. After 4 weeks treatment, the negativity of serum PCR HBVDNA was 87. 1% in treatment group, it was 85, 1% in control group （P 〉 0. 05 ）. The failure rate of the treatment group and the control group are 15.2 % （5/33） and 40. 0% （12/30） （ P 〈 0. 05 ）. The complications of hepatorenal syndrome （HRS） and hepatic encephalopathy（HE） occur in control group more than that in treatment group （ P 〈 0. 05）. Conclusion Glucocorticoids combined with antiviral therapy have a remarkable effect on early stage of chronic severe hepatitis B and both are very safe.