糖皮质激素治疗重型肝炎的疗效评价

Therapeutic effect of glucocorticoids in patients with severe hepatitis

目的探讨糖皮质激素治疗早期重型肝炎的临床疗效。方法在综合治疗的基础上，治疗组加用激素，每日地塞米松5—7mg静脉输入，1周后开始减量，逐渐改为强的松30mg，每日清晨口服，待胆红素消退大于2／3以上时，强的松减量维持，直至胆红素下降到正常2倍左右渐停，同时加用奥美拉唑静滴或口服，5％碳酸氢钠漱口，喹诺酮类药物预防感染。凡有乙肝病毒复制，HBV—DNA〉10^4copy／ml者，均加用拉米夫定100mg每日1次口服。结果治疗组好转率明显高于对照组，2组比较差异有显著性（P〈0．01）。结论激素用于早期重型肝炎，可快速改善症状、缩短病程、改善肝功能，疗效明显，副作用小。

Objective To investigate the efficacy of glucoeorticoid in patients with severe hepatitis. Methods On the basis of combination therapy,the patients were divided into two groups. The test group was treated with additional 5 -7rag dose of dexamethasone through intravenous injection for one week. Then the dose was gradually decremented until at last was replaced by prednisone at the dose of 30mg every morning for oral use. When the bilirubin was reduced to 2/3 ,the prednisone should be gradually decremented till zero when the bilirubin came to 2 times of the normal value. At the same time, the test group was treated with omeprazole for oral use or intravenous injection and 5% sodium bicarbonate for gargle and quinolones to prevent ＇infection. Additional 100mg lamivudine was taken orrally once daily by those who had the HBVDNA 〉 104 copy/ml. Results The treatment group better had therapeutic effect than the control group. The difference between the two groups was significant （ P 〈 0. 01 ）. Conclusion At the nonage of the severe hepatitis the glucoeorticoid can help improve the symptom,reduce the course of disease and ameliorate liver function. It has an obvious therapeutic effect and little side effects.