糖皮质激素联合非生物型人工肝治疗重症药物性肝损伤疗效及安全性

目的评估糖皮质激素联合非生物型人工肝治疗重症药物性肝损伤的效果及安全性。方法对激素联合人工肝治疗的96例重症药物性肝损伤患者进行回顾性分析,记录其治疗过程及血常规、肝功能等指标,观察其有效率及并发症。结果 96例重症药物性肝损伤患者治疗有效者84例,无效12例,治疗后RBC(4.22±0.70)×109/L、Hb(127.88±22.99)g/L较前升高,差异有统计学意义(P0.05);ALT(145.48±158.94)U/L、AST(98.06±69.26)U/L、TBil(165.10±124.21)μmol/L、DBil(130.66±89.46)μmol/L、IBil(35.43±37.48)μmol/L、Alb(41.12±30.93)g/L、ALP(178.64±119.65)U/L较治疗前有明显改善,差异均有统计学意义(P0.05);BUN(5.61±2.59)mmol/L、Cre(61.00±14.36)μmol/L较前升高,差异有统计学意义(P0.05),血凝各指标较前无明显变化,差异无统计学意义(P0.05)。结论激素联合人工肝治疗重症药物性肝损伤患者,疗效肯定,安全性较好,可延缓病情进展,降低肝衰竭发生率。

Efficacy and safety of glucocorticoid with non-bioartificial liver support system in the treatment of severe drug-induced liver injury

Objective To evaluate efficacy and safety of glucocorticoid (GC) with non-bioartificial liver support system (NBLS) in the treatment of severe drug-induced liver injury (DILI).Methods In the retrospective study,96 cases with severe DILI who had underwent the treatment of GC combined NBLS in our hospital from January 2008 to December 2015 were enrolled.Treatment,blood routine,liver functions,and so on,were recorded.The efficacy and complications of GC combined with NBLS in treating severe DIM were observed.Results Treatment of GC combined with NBLS was effective in 84 cases (87.5％).Levels of red blood cell (RBC) (4.22 ± 0.70) × 109/L and hemoglobin (Hb) (127.88 ±22.99) g/L were significantly higher at baseline than those after treatment (P＜0.05).Levels of alanine aminotransferase (ALT) (145.48± 158.94) U/L,aspartate amino transferase (AST)(98.06 ± 69.26) U/L,total bilirubin (TBil) (165.10 ± 124.21) μtmol/L bilirubin tra,direct bilirubin (DBil) (130.66 ± 89.46) μmol/L,indirect bilirubin (IBil) (35.43 ± 37.48) μmol/L,albumin (Alb) (41.12 ± 30.93) g/L and alkaline phosphatase (ALP) (178.64 ± 119.65) U/L were significantly improved compared to those before treatment (P＜0.05).However,levels of blood urea nitrogen (BUN) (5.61 ± 2.59)mmol/L and cre-recombinase (Cre) (61.00 ± 14.36) μmol/L in renal function were significantly higher after treatment (P＜0.05).No significant difference was observed in the level of prothrombin time (PT) and plasma thromboplastin antecedent (PTA) (P＞0.05).Conclusion The treatment of GC with NBLS showed satisfactory effectiveness and safety for severe DILI,which could ameliorate the disease progression,reduce total incidence of liver failure and improve the prognosis.