糖皮质激素递减疗法治疗乙型肝炎肝衰竭患者的疗效及安全性分析*

目的 探讨糖皮质激素递减疗法治疗乙型肝炎肝衰竭患者的临床疗效及安全性。方法 选择64例慢加急性乙型肝炎肝衰竭患者，随机分为观察组32例和对照组32例。给予对照组保肝、拉米夫定抗病毒、支持疗法等综合治疗，观察组在综合治疗的基础上给予甲基强的松龙注射液1 mg?kg-1?d-1静脉滴注，并根据临床病情改善情况递减激素用量，比较两组患者治疗后病死率、并发症发生率，肝功能、HBV DNA水平等变化情况。结果 观察组与对照组并发症发生率分别为12.5%和25.0%（P<0.05）；观察组与对照组消化道改善时间分别为（3.8±1.3）d和（15.5±1.8）d，P＜0.01]，黄疸消退时间分别为（28.2±9.3）d和（41.5±10.3）d，P＜0.05]；住院日分别为（41.5±4.3） d和（52.2±4.7）d，P＜0.05]；观察组PTA和ALB较对照组升高显著，ALT和TBIL水平降低明显（P<0.05）；观察组与对照组血清HBV DNA水平分别为（3.2±1.5）lg cps/ml和（3.3±1.3）lg cps/ml，P＞0.05]；观察组与对照组病死率分别为9.4%和21.9%（P＜0.05）。结论 糖皮质激素递减疗法治疗乙型肝炎肝衰竭患者可提高治疗效果，降低病死率，并具有较高的安全性。

Efficacy and safety of glucocorticoid-decreasing-dose therapy in patients with hepatitis B-induced liver failure

Objective To investigate the efficacy and safety of glucocorticoid-decreasing-dose therapy in patients with hepatitis B-induced liver failure. Methods 64 patients with hepatitis B-induced acute-on-chronic liver failure at early stage were recruited in this study，and they were randomly divided into observation group and control group with 32 cases in each. The patients in control group were given the comprehensive treatment with hepatoprotective，antiviral，and supporting therapy，and the patients in observation group were intravenously given the treatment of methylprednisolone at dose of 1 mg?kg-1?d-1 at the base of comprehensive treatment. The mortality， complications，liver function index， serum HBV DNA levels were compared between the two groups after treatment. Results The occurrences of complications in observation and control groups were 12.5% and 25.0%，respectively（P<0.05）；the improvement of gastrointestinal symptoms took （3.8±1.3） d and（15.5±1.8） d，P＜0.01]，the disappearance of jaundice took （28.2±9.3）d and （41.5±10.3）d，P＜0.05]，and the hospital stay were （41.5±4.3） d and（52.2±4.7）d，P＜0.05]，respectively in the two groups；the prothrombin time activity and serum albumin levels increased，and serum alanine aminotransferase and bilirubin levels decreased in observation group more obviously than in control（P<0.05）；serum HBV DNA levels were （3.2±1.5）lg cps/ml and （3.3±1.3）lg cps/ml，P＞0.05]，and the fatality rates were 9.4% and 21.9% （P＜0.05） in the two groups. Conclusion The application of glucocorticoids in treatment of patients with liver failure can improve the therapeutic effect and reduce mortality with relative high security.