糖皮质激素治疗重症药物性肝损伤的临床研究

目的探索糖皮质激素治疗重症药物性肝损伤的疗效和安全性。方法 37例重症药物性肝损伤患者分为激素治疗组16例和对照组21例。对照组采用常规保肝、退黄药物方案;激素组在对照组治疗基础上,加用小剂量、短疗程糖皮质激素治疗,观察生化学应答情况、有效率和安全性。结果激素治疗组生化学应答较早,ALT、AST、TBil、DBil、ALP水平在治疗2周时分别为(93.2±65.6)U/L;(61.7±30.7)U/L;(168.3±98.9)μmol/L;(124.7±81.4)μmol/L;(117.2±40.1)U/L、4周时分别为(52.6±32.0)U/L;(77.4±144.1)U/L;(88.9±59.7)μmol/L;(64.7±48.4)μmol/L;(116.6±63.1)U/L均较治疗前(172.9±104.8)U/L;(264.7±169.7)U/L;(259.1±108.8)μmol/L;(182.2±82.4)μmol/L;(153.8±69.9)U/L显著降低(P均0.05);对照组治疗2周仅ALT、AST降低明显(P0.05),而TBil、DBil于治疗4周后方明显降低(P均0.05);两组GGT治疗前后均无显著改善(P0.05)。治疗4周时激素组治疗有效率、显效率均显著高于对照组(93.8%比66.7%,χ~2=11.919,P=0.001;87.5%比57.1%,χ~2=6.081,P=0.014)。两组总体不良反应发生率差异无统计学意义(P0.05)。结论早期应用小剂量、短疗程糖皮质激素,可有效地治疗重症药物性肝损伤,且安全性较好。

Treatment response of glucocorticoid in severe drug-induced liver injury

Objective To investigate the efficacy and safety of glucocorticoid in treatment of severe drug-induced liver injury (DILI).Methods Thirty-seven patients with severe DILI were divided into control group (n=21) and glucocorticoid group (n=16),who received only conventional therapy and conventional therapy plus small dose of glucocorticoid in short course,respectively.Results In glucocorticoid group,levels of alanine aminotransferase (ALT),aspartate transaminase (AST),total bilirubin (TBil),direct bilirubin (DB) and alkaline phosphatase (ALP) were significantly decreased at week 2 (93.2±65.6;61.7±30.7;168.3±98.9;124.7±81.4;117.2±40.1) and week 4 (52.6±32.0;77.4±144.1;88.9±59.7;64.7±48.4;116.6±63.1) after treatment compared to those in baseline (172.9±104.8;264.7±169.7;259.1±108.8;182.2±82.4;153.8±69.9),respectively (P<0.05).In control group,ALT and AST levels were significantly lower at week 2 (P<0.05),and the serum levels of TB and DB decreased significantly at week 4 (P<0.05).The efficiency and effectiveness of treatment in glucocorticoid group were significantly higher than those in control group (93.8％ vs 66.7％,X2=11.919,P=0.001;87.5％ vs 57.1％,X2=6.081,P=0.014).There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).Conclusion Early medication of small dose glucocorticoid with short course might be effective and safe for severe DILI.