糖皮质激素治疗乙型肝炎早期肝衰竭的疗效观察

The clinical efficacy of glucocorticoid in the treatment of hepatitis B-related early-stage liver failure

目的探讨糖皮质激素治疗乙型肝炎早期肝衰竭的临床疗效。方法将48例乙型肝炎早期肝衰竭患者随机分为激素治疗组(治疗组)26例和非激素治疗组(对照组)22例,两组均行护肝、退黄、促肝细胞生长、抗乙肝病毒、血浆支持等综合治疗;在此基础上激素治疗组加用1mg/(kg·d)甲基强的松龙静滴,3d后逐渐减量,并持续至2周后停用,观察两组消化道症状及丙氨酸转氨酶(ALT)、总胆红素(TBIL)、凝血酶原活动度(PTA)的变化。结果治疗组病死率较对照组低,差异有统计学意义;治疗组治疗后1周、2周、4周与对照组比较ALT、TBIL、PTA差异均有统计学意义;治疗组消化道出血、感染发生率与对照组比较,差异无统计学意义。结论糖皮质激素用于乙型肝炎早期肝衰竭疗效明显,不良反应小。

Objective To investigate the clinical efficacy of glucocorticoid in the treatment of hepatitis B-related early-stage liver failure. Methods Forty-eight patients with hepatitis B-related early-stage liver failure were randomly divided into a hormone therapy group （the treatment group）with 26 cases and non-hor-mone treatment group （the control group）with 22 cases.Both groups received comprehensive treatment such as liver protection,treating j aundice,promoting hepatocyte growth,anti-hepatitis B virus,plasma support, etc.On this basis,the hormone therapy group were added with intravenous methylprednisolone 1 mg/（kg· d）,gradual reduction after 3 days,and hormone was used two weeks continuously till the end.The observa-tion of gastrointestinal symptoms and alanine aminotransferase （ALT）,total bilirubin （TBIL）,prothrombin activity （PTA）changes were done for two groups patients. Results The treatment group had lower mortali-ty rate than the control group,the comparison between the two groups showed statistical difference;one week, two weeks and four weeks after treatment,comparison of ALT,TBIL,PTA in the treatment group with the control group yielded statistically significant differences.Comparison of the incidence rates of gastrointestinal bleeding and infection in the treatment group with the control group was done,but there was no statistical difference. Conclusion Glucocorticoid for hepatitis B-related early liver failure is obviously effective with less side effects.