地塞米松治疗有重症倾向的慢性乙型肝炎的临床观察

The clinical effect of dexamethasone in the treatment of chronic hepatitis B(CHB)with tendency to fulminant hepatitis

目的观察地塞米松对有重症倾向的慢性乙型肝炎患者的疗效及预后。方法将120患者分为3组,A组保肝抗炎、保护胃黏膜、预防感染、对症支持等综合治疗;B组在A组基础上加用地塞米松10mg冲击治疗3～5d后停用;C组在A组治疗基础上地塞米松3mg,间隔48～72h再使用,疗程6周。结果治疗6周,B组、C组总胆红素水平、消化道症状改善、重症肝炎发生率与A组比较有统计学意义(P<0.05)。C组并发症与B组对比差异显著(P<0.05)。结论有重症倾向的慢性乙型肝炎患者采用地塞米松冲击治疗或小剂量间断使用可以早期缓解消化道症状、降低重症肝炎发生率,但小剂量间断使用疗法更易出现并发症,地塞米松短期冲击治疗更安全。

Objective To observe the curative effect and prognosis of dexamethasone in the treatment of chronic hepatitis B （CHB）with tendency to fulminant hepatitis.Methods 120 patients were assigned into three groups.In group A,patients received drug of protecting liver, protecting gastric mucosa,preventing infection and other symptomatic supportive treatment.In group B,patients received dexamethasone 10-20mg during the first 3-5 days on the basis of group A.In group C, patients received dexamethasone 3-5mg once 48-72 hours for 6 weeks on the basis of group A.Results At week 6,there was significant difference between B and A groups,and also between C and A groups in the total serum bilirubin level,improvement of digestive symptoms and the total incidence of severe hepatitis （P≤0.05）.There was significant difference in the rate of complications between B and C groups.Conclusion Patients of chronic hepatitis B （CHB）with tendency to fulminant hepatitis who received a low-dose dexamethasone discontinuously or dexamethasone pulse therapy can improve digestive symptoms and reduce the total incidence of severe hepatitis,but the patients who received the treatment of low-dose dexamethasone discontinuously have more complications than those who received dexamethasone pulse therapy.Shortterm dexamethasone pulse therapy is an safe and.effective treatment for treating patients who were chronic hepatitis B （CHB）with severe tendency.