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短程地塞米松不能提高乙型肝炎慢加急性肝衰竭生存率[J]. 中山大学学报(医学科学版), 2014,35(1).
Dexamethasone Can not Improve Survival Rate of Patients with HBV ACLF[J]. Journal of Sun Yat-sen University (Medical Sciences), 2014, 35(1).
摘 要: 【目的】 评估小剂量地塞米松治疗早期慢加急性乙肝肝衰竭患者的疗效及安全性。【方法】 选取2009年1月至2012年12月138例慢加急性乙肝肝衰竭患者,所有患者均接受内科标准治疗(SMT),其中35例患者在标准内科综合治疗基础上,通过外周静脉每天推注10 mg地塞米松,共3 d(DMT组),按照基线匹配原则选取35例为对照组(SMT组),随访12周。观察患者生存情况以及治疗不同时间点肝功能、并发症发生率情况。【结果】 SMT组及DMT组12周累计生存率分别为45.7%(16/35)、54.3%(19/35),P = 0.654。2组患者入组后1、2、4、8、12周各时间点两组患者之间谷丙转氨酶、白蛋白、总胆红素、凝血酶原时间国际标准化比值、MELD评分差别无统计学意义。两组患者感染、上消化道出血、肝性脑病、肝肾综合症、电解质紊乱以及腹水6种并发症的发生率无统计学差异。40岁以上,MELD积分28以上以及肝性脑病是患者死亡的独立危险因素。【结论】 小剂量地塞米松治疗早期慢加急性乙肝肝衰竭不能改善肝功能,提高患者生存率。年龄、MELD评分、肝性脑病是评估预后的独立危险因子。
Abstract: 【Objective】 Acuteonchronic liver failure (ACLF) caused by hepatitis B virus (HBV) is a severe disease with high mortality. Immune injury plays an important role during the early stage of the disease. The safety and efficacy of dexamethasone for patients with HBV ACLF is unknown. 【Methods】 A total of 138 inpatients with the diagnosis for HBV induced ACLF were enrolled from January 2009 to December 2012. All the patients received the standard medicine treatment, among whom 35 cases underwent additional dexamethasone injection for 3 times (DMT Group). A total of 35 patients (SMT Group) matched for baseline characters served as controls. Both the groups were followed up for 12 weeks. The survival of patients, liver functions and complications were recorded. 【Results】 The 12week cumulative survival rate were 45.7% (16/35) and 54.3% (19/35) for SMT Group and DMT Group respectively, and no significant differences were found (P = 0.654). There were no dramatic differences in the levels of alanine aminotransferase (ALT), albumin (ALB), total bilirubin (TBil), international normalized ratio (INR), and Model for EndStage Liver Disease (MELD) at 1, 2, 4, 8, and 12 weeks after enrollment between two groups. There were no significant differences in the incidence of complications (i.e., infection, gastrointestinal bleeding, encephalopathy, hepatorenal syndrome, electrolyte disturbance and ascites) from 112 weeks between Group SMT and Group DMT. More than 40 ages, MELD Score more than 28 and encephalopathy were independent risk factors. 【Conclusion】 Dexamethasone can not improve liver function and 12week survival rate of patients with HBV ACLF. The age, MELD Score and encephalopathy are independent risk factors.
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