糖皮质激素治疗早期肝衰竭的临床疗效观察

Effect of glucocorticoid in treatment of patients with early liver failure

目的观察糖皮质激素治疗早期肝衰竭的疗效。方法 51例肝衰竭早期患者随机分为对照组24例和治疗组27例,对照组采用保肝、退黄、对症支持等内科综合治疗,治疗组在此基础上加用氢化可的松琥珀酸钠,用量按150～200mg/d,使用1周后逐渐减量,改为泼尼松口服,直至停药。疗程为8周,观察患者临床症状、生化学指标及激素不良反应。结果两组在8周治疗过程中丙氨酸转氨酶(ALT)、总胆红素(TBIL)呈逐渐下降趋势,治疗组ALT从治疗前(652.3±201.5)U/L到治疗后(40.8±12.2)U/L,对照组从治疗前(623.4±182.7)U/L到治疗后(57.3±14.8)U/L,治疗组TBIL从治疗前(312.7±90.5)μmol/L到治疗后(30.6±8.5)μmol/L,对照组从治疗前(298.6±94.2)μmol/L到治疗后(44.6±10.3)μmol/L,两组在组间、不同时点以及组间和不同时点的交互作用差异有统计学意义(P<0.01);白蛋白(ALB)、总胆固醇(TC)、凝血酶原活动度(PTA)呈逐渐上升趋势,治疗组ALB从治疗前(24.9±3.5)g/L到治疗后(31.4±4.5)g/L,对照组从治疗前(25.2±3.6)g/L到治疗后(30.5±4.1)g/L;治疗组TC从治疗前(2.0±0.3)mmol/L到治疗后(3.0±0.4)mmol/L,对照组从治疗前(2.0±0.5)mmol/L到治疗后(3.0±0.2)mmol/L;治疗组PTA从治疗前(37.2±11.3)%到治疗后(70.4±17.9)%,对照组从治疗前(35.3±10.9)%到治疗后(60.1±7.1)%,两组在组间、不同时点以及组间和不同时点的交互作用差异有统计学意义(P<0.01);治疗组的治愈好转率比对照组高(88.9%vs 62.5%,P<0.05)。治疗组发生低钾血症、血糖升高和白细胞升高率高于对照组,分别为48.1%vs 20.8%、37.0%vs 8.3%和51.9%vs 16.7%(P<0.05或<0.01)。结论肝衰竭早期合理应用糖皮质激素治疗有良好效果,降低患者不良反应发生率。

Objective To explore the effect of glucocorticoid in the treatment of patients with early liver failure.Methods Fifty-one patients with early liver failure were randomly divided into control group（24 cases） and treatment group（27 cases）.The patients of control group were treated with liver protection,jaundice decrease,and supportive medical comprehensive treatment,those of treatment group were added with hydrocortisone succinate,dose 150-200 mg/d on the basis of these above measures,and one week later the dose was gradually reduced,then the medicine was changed to oral prednisone until withdrawal.The treatment course lasted for eight weeks.Clinical symptoms,biochemical indexes and glucocorticoid adverse reactions in patients were observed.Results During the eight weeks＇ treatment,alanine aminotransferase（ALT） and total bilirubin（TBIL） appeared to have a gradually decline tendency in two groups,in treatment group,ALT before treatment from（652.3±201.5） U/L to after treatment（40.8±12.2） U/L,in control group,ALT before treatment from（623.4±182.7） U/L to after treatment（57.3±14.8） U/L,in treatment group,TBIL before treatment from（312.7±90.5） μmol/L to after treatment（30.6±8.5） μmol/L,in control group,TBIL before treatment from（298.6±94.2） μmol/L to after treatment（44.6±10.3） μmol/L,the differences of interblock,time dissimilarity and interaction of interblock with time dissimilarity between the two groups had statistical significance（P0.01）.During the eight weeks＇ treatment,albumin（ALB）,total cholesterol（TC） and prothrombin activity（PTA） appeared to have a gradually increase tendency in two groups,in treatment group,ALB before treatment from（24.9±3.5） g/L to after treatment（31.4±4.5） g/L,in control group,ALB before treatment from（25.2±3.6） g/L to after treatment（30.5±4.1） g/L,in treatment group,TC before treatment from（2.0±0.3） mmol/L to after treatment（3.0±0.4） mmol/L,in control group,TC before treatment from（2.0±0.5） mmol/L to after treatment（3.0±0.2） mmol/L,in treatment group,PTA before treatment from（37.2±11.3）% to after treatment（70.4±17.9）%,in control group,PTA before treatment from（35.3±10.9）% to after treatment（60.1±7.1）%,the differences of interblock,time dissimilarity and interaction of interblock with time dissimilarity between the two groups had statistical significance（P0.01）.The improvement rate in treatment group was higher than that of control group（88.9% vs 62.5%,P0.05）.The incidences of hypokalemia,hyperglycemia and leukocytosis in treatment group were higher than those of control group,respectively as 48.1% vs 20.8%,37.0% vs 8.3% and 51.9% vs 16.7%（P0.05 or 0.01）.Conclusion Early reasonable application of glucocorticoid treatment in patients with liver failure has positive effect and can reduce the incidence of adverse effects.