糖皮质激素治疗药物性肝损伤重症倾向的临床研究

The clinical study of glucocorticoid in drug induced liver injury with tendency to fulminant hepatitis

目的观察糖皮质激素对有重症倾向的药物性肝损伤(DILI)患者的疗效及预后。方法将52例有重症倾向的DILI患者随机分为治疗组(n=24)和对照组(n=28),两组均给予常规保肝、降酶及支持等治疗,在此基础上治疗组加用小剂量糖皮质激素。监测两组患者治疗前后临床症状、生化指标、预后指标等。结果治疗14 d和30 d后,治疗组总胆红素水平、消化道症状和重症肝炎发生率与对照组比较差异有统计学意义(P<0.05)。两组出现上消化道出血、继发感染等并发症的情况差异无统计学意义。结论在常规护肝治疗的基础上,加用小剂量糖皮质激素短期治疗有重症倾向的DILI是安全有效的,早期使用可缓解消化道症状,降低重症肝炎发生率。

Objective To observe the curative effect and prognosis of glucocorticoid in the treatment of drug induced liver injury（DILI）with tendency to fulminant hepatitis.Methods 52 DILI patients were assigned into treatment group（24 cases） and control group（28 cases）.Two groups were given protecting live,reducing enzyme and supportive treatment.On this basis,treatment group added with small doses of glucocorticoids.They were monitored clinical symptoms,biochemical parameters and prognosis indicators before and after treatment.Results After 14 days and 30 days,there was significant difference between treatment group and control group in the serum bilirubin level,improvement of digestive symptoms and the total incidence of severe hepatitis（P〈0.05）.There was no significant difference in the rate of upper gastrointestinal bleeding,secondary infection and other complications between two groups.Conclusion Patients of DILI with tendency to fulminant hepatitis who receive a low dose glucocorticoid therapy can improve digestive symptoms and reduce the total incidence of severe hepatitis.On the basis of the routine therapy,short term glucocorticoid therapy may be a safe and effective treatment for DILI with tendency to fulminant hepatitis.