糖皮质激素对重症药物性肝损伤的疗效分析及剂量选择

Efficacy and dose selection of glucocorticoid for severe drug⁃induced liver injury

目的 探讨糖皮质激素对重症药物性肝损伤患者的疗效及剂量选择。方法 收集2018年9月至2021年8月于郑州大学第一附属医院就诊的232例重症药物性肝损伤患者资料,根据病程中是否使用糖皮质激素及其剂量分为:激素组(进一步分为<0.5 mg/(kg·d)组和≥0.5 mg/(kg·d)组)和对照组,并比较激素组与对照组间、不同剂量激素组间ALT、AST、DBIL、IBIL、TBIL疗效差异及并发症分析。结果 (1)激素组与对照组间住院时间差异有统计学意义(P <0.05),激素组为18.00(13.00,24.00)d,对照组为21.00(15.00,29.00)d。激素组与对照组间AST、DBIL、IBIL、TBIL较基线下降30%、50%所需时间差异有统计学意义(P <0.05),ALT较基线下降30%、50%所需时间差异无统计学意义(P> 0.05)。(2)不同剂量激素组间AST、ALT、DBIL、IBIL、TBIL较基线值降低30%、50%所需时间差异无统计学意义(P>0.05)。(3)激素组与对照组间、不同剂量激素组间感染相关不良反应差异有统计学意义(P <0.05)。结论 糖皮质激素联合常规保肝药物能更快改善重症药物性肝损伤患者AST、DBIL、IBIL、TBIL水平,不同剂量糖皮质激素对ALT、AST、DBIL、IBIL、TBIL的疗效无明显差异,但当激素组剂量≥0.5 mg/(kg·d)时,感染发生率更高。

Objective To investigate the efficacy and dose selection of glucocorticoid in severe drug⁃induced liver injury.Methods Data of 232 patients with severe drug⁃induced liver injury who admitted to The First Affiliated Hospital of Zhengzhou University hospital from September 2018 to August 2021 were collected.According to the use of glucocorticoid and their dose during the course of disease,they were divided into hormone group(further divided into<0.5 mg/(kg·d)group and≥0.5 mg/(kg·d)group)and control group.The efficacy of ALT,AST,DBIL,IBIL,TBIL and complication were analyzed,between hormone group and control group,different dose of hormone group.Results(1)The mean hospital stay between the hormone group and the control group was statistically different(P<0.05),the number of days of hospitalization in the hormone group was 18.00(13.00,24.00)days,and that in the control group was 21.00(15.00,29.00)days.There was statistical difference between two group in the time required for the reduction of AST,DBIL,IBIL and TBIL by 30%and 50%compared with the baseline value(P<0.05).There was no statistical difference between two group in the time required for the reduction of ALT by 30%and 50%compared with the baseline value(P>0.05).(2)The days of ALT,AST,DBIL,IBIL and TBIL decrased by 30%,50%compared with the baseline value in the different doses of hormone group was no statistically difference(P>0.05).(3)There were statistically difference in infection⁃related adverse reactions between the hormone group and the control group,and between different doses of hormone group(P<0.05).Conclusion Glucocorticoid combined with conventional liver⁃protecting drugs can improve the levels of AST,DBIL,IBIL and TBIL in the patients with severe drug⁃induced liver injury.There was no statistical difference in the improved of ALT,AST and TBIL with different doses of glucocorticoid,but when the dose of hormone group was≥0.5 mg/(kg·d),the incidence of infection was higher.