肾上腺糖皮质激素治疗淤胆型肝炎55例临床疗效分析

Clinical Effects of Glucocorticoids on Cholestatic Hepatitis:a Report of 55 Cases

目的探讨淤胆型肝炎的临床特点、常见发病原因以及肾上腺糖皮质激素对减轻黄疸及缩短病程的疗效分析。方法回顾性分析安庆市立医院2004～2010年收住入院的55例淤胆型肝炎的临床特点、常见病因及肾上腺糖皮质激素治疗效果。结果淤胆型肝炎根据病程可分为急性、慢性两种,男女性别之间发病率无明显差异,临床表现中临床症状较轻,但黄疸较深表现为重度黄疸,且持续时间均超过3周以上,有明显皮肤瘙痒及大便色泽改变,体检有明显肝肿大或肝硬化表现,肝功能中血清胆红素以直接胆红素增高为主,PTA大于60%,GGT、AKP、TBA、CHO等升高,ALT初期升高,中后期可正常。病因中急性淤胆型肝炎以嗜肝病毒、药物损害为主,且近年中药损害有上升趋势,而慢性淤胆型肝炎以自身免疫性肝病和慢性乙肝为常见。结论应用肾上腺糖皮质激素治疗可明显减轻黄疸及缩短病程。短期治疗(1周内)黄疸均有明显下降,但不同病因效果有所差异,部分需长期维持治疗。

Objective To study the clinical characteristics,common cause of the cholestatic hepatitis and the curative effects of glucocorticoids in relieving jaundice and shortening the course of disease.Methods The clinical characteristics,common cause of the cholestatic hepatitis and the curative effects of glucocorticoids of 55 cases with cholestatic hepatitis from 2004 to 2010 were analyzed retrospectively.Results The cholestatic hepatitis can be divided according to the course into acute and chronic cholestatic hepatitis,without obvious difference between men and women in the incidence.Severe jaundice last for more than three weeks was the main clinical manifestations.Most patients were with clearly pruritus and changes in stool color.The physical examination showed hepatomegaly or cirrhosis.The direct bilirubin levels increased;PTA was more than 60%;GGT,AKP,TBA and CHO also increased;ALT rose at the early stage and recovered at the later period.The hepatotropic virus infection and drug damage were the main pathogenesis of the acute cholestatic hepatitis,and the later had an escalating trend;and the autoimmune liver disease and chronic hepatitis B were responsible for the chronic cholestatic hepatitis.Conclusion The procedure with glucocorticoids can significantly reduce the jaundice and shorten the course of the disease.A short-term treatment（within a week） can obviously decrease the jaundice,and gain different curative efficiency according to the different pathogenesis;some cases need a long-term maintenance treatment.