糖皮质激素阻断慢性乙型肝炎肝衰竭发生的临床对照观察

目的应用糖皮质激素治疗慢性乙型肝炎重度试图阻断重型肝炎的发生。方法 120例慢性乙型肝炎重度患者随机分为常规治疗组(58例)和在常规治疗基础上加用糖皮质激素治疗组(62例)。结果在激素治疗组,只有22％(14/62)的患者发展至慢性重型肝炎,显著低于常规治疗组的48％(28/58,X2=7.60,P<0.01)。在常规治疗组53.6％(15/28)的慢性重型肝炎患者死亡,而在激素治疗组,仅28.6％(4/14)的患者死亡(X2=0.02,P>0.05)。除在激素治疗组出现一些能控制的特殊感染外,两组的出血、感染发生率差异无显著性。结论在基础治疗的支持下,及时应用皮质激素能阻断部分慢性乙型肝炎重度患者发展到重型肝炎。激素治疗的成败取决于强有力的支持疗法、科学的给药方法和严格的管理。

Glycocorticosteroid administration prevents fulminant hepatic failure occurrence in patients with chronic hepatitis B of severe degree

Objective To prevent chronic severe hepatitis, even more fulminant hepatic failure (FHF) occurrence in patients with chronic hepatitis B of severe degree using steroid. Methods 120 patients were randomized into conventional supporting treatment and steroid treatment groups. The latter, 62 patients were given intravenously hytrocortisone sodium succi-nate at the dose of 150 mg-200 mg everyday plus support care. Results The rate of deteriorating to chronic severe hepatitis in steroid treatment group was significantly lower than that of conventional group (22% vs 48%, x2=7.60, P<0.01). 53.6% (15/28) patients with chronic severe hepatitis in conventional group died, while only 28.6% (4/14) in steroid treatment group succumbed to terminal liver disease ( x2=0.02, P>0.05). There was no difference between the two groups regarding to complications sincidence: gastrointestinal bleeding and infections except for some controllable serious reverse events, such as candidiasis, diabetes, herpes zoster and pulmona tuberculosis found in some patients in steroid-treated group. Conclusions These results suggest that steroid administration with improved support care not only is likely to prevent chronic severe hepatitis occurrence in patients with chronic viral hepatitis of severe degree, but also shows some efficacy for FHF, which warrant further investigation.