早期糖皮质激素联合抗病毒药物治疗重型乙型肝炎病例对照研究

A Case-control study of the combined therapy with glucocorticoid and antiviral treatment at earlystage of severe chronic hepatitis B

目的探讨糖皮质激素治疗早期重型乙型肝炎的临床疗效。方法将56例重型乙型肝炎早期患者随机分为糖皮质激素治疗组（实验组）与常规治疗组（对照组）。观察两组治疗前后总胆红素、凝血酶原时间、谷丙转氨酶及并发症发生率的情况。结果（1）实验组与对照组治疗后ALT均有改善（P〈0．05），两者治疗后感染、出血及肝性脑病等并发症发生元统计学差异（P〉0．05）。（2）实验组治疗前后血清总胆红素、凝血功能明显改善（P〈0．05），对照组治疗前后比较总胆红素、凝血功能差异均无统计学意义（P〉0．05），两组治疗后，实验组白细胞明显高于对照组（P〈0．05），但仍在正常值范围之内。结论在重型乙型肝炎早期，短期、中等剂量使用糖皮质激素对于黄疸下降及凝血功能的改善优于常规治疗，且未增加感染、出血等常见并发症的发生率，但其对临床预后的影响还需进一步深入研究.

Objective To assess the clinical effect of glucocorticoid in the treatment at the early- stage of severe chronic hepatitis B. Methods Fifty-six patients with early-stage HBV-related liver failure were divided randomly into glucocorticoid treatment group （experimental group） and routine integrated treat- ment group （control group）. The total bilirubin （TBil）, alanine transaminase （ALT）, prothrombin time （PT） and the incidence of complications before and after the treatments in both groups were compared. Resuits （1） ALT decreased significantly after treatment in both groups（P 〈 0. 05）, and the incidence of com- plications showed no significant differences between the two groups （P 〉 0. 05）. （2） In the experimental group, TBil and VF decreased significantly after treatment （ P 〈 0. 05）, but there was no significant improvement in the control group （P 〉 0. 05）. White blood cells count was significantly higher in the experimental group than control group after treatment （ P 〈 0.05）, but still in the normal range. Conclusions The short- term moderate-dose of giucocorticoid treatment can improve liver functions and coagulation function of patients with HBV-related early-stage liver failure. Gulcocortieoid treatment will not increase the incidences of common complications, including gastrointestinal bleeding, infection, hepatic encephalopathy （HE）, etc. However, the exact clinical effect of glucocorticoid needs further research.