摘要
目的暴发性肝衰竭的命名和诊断标准国内外一直存在争议。我国的慢性重型肝炎称谓在译成英文后,易与慢性肝炎重度混淆,且由于其潜在的基础肝病(乙型肝炎病毒携带者,慢性肝炎和肝硬化)不同,使其的治疗、预后也不同,并且由于在临床诊断要素方面的不确定性,使我们的研究论文很难被国外学者所承认。方法我们试探性修改并给出了乙型肝炎的临床分型标准。122例慢性乙型肝炎重度患者进入本研究。59例患者接受常规的护肝治疗措施;63例皮质激素治疗组在常规治疗的基础上给予氢化可的松琥珀酸钠150～200mg/d×7～10d;对无反应的患者,病情进展至坏死性或衰竭性肝炎时,加强支持治疗,皮质激素的剂量维持不变,待黄疸降至100μmol/L 以下时开始减量治疗至治愈停药(约3～5月)或死亡。结果在激素治疗组,22％(14/63)的患者发展至坏死性肝炎,显著低于常规治疗组的49％(x^2=8.54,P<0.01);在常规治疗组,55.2％(16/29)的坏死性肝炎患者死亡,而激素治疗组的病死率为28.6％(4/14,x^2=1.72,P>0.05)。尽管在皮质激素治疗组发生了一些能控制的严重感染,如白色念珠菌1例,糖尿病3例,带状疱疹和肺结核1例,两组的消化道出血、感染发生率无显著相差。结论结果提示,在基础治疗的支持下,皮质激素能阻断部分慢性乙型肝炎重度患者发展至坏死性肝炎,并能降低后者的病死率,值得进一步研究。
Objective The aim of this randomized controlled trial was to compare the efficacy of glyco- corticosteroids versus conventional therapy in preventing illness exacerbation in chronic hepatitis B.Methods one hundred and twenty-two consecutive patients with chronic hepatitis B of severe degree were randomized to conventional support measure and steroid groups.In sixty-three patients an intravenous hytrocortisone sodium succinate was given at a dose of 150mg to 200mg/daily plus support care.The support care with blood products and symptomatic management was enhanced in patients with chronic necrotic hepatitis in both groups and the steroid therapy continued at the same doses as at initiation in steroid group.Results Twenty-two percent (14/63) of patients in steroid treatment deteriorated to chronic necrotic hepatitis.significantly lower than forty- nine percent (29/59) in conventional group (X^2=8.54,P<0.01).55.2% (16/29) of patients with chronic necrotic hepatitis in conventional group died, whereas only 28.6% (4/14) in steroid treatment succumbed to terminal liv- er diseases (X^2=1.72,P>0.05).There was no significant difference in the two groups regarding complication incidence of gastrointestinal bleeding and infections except for controllable serious reverse effects,such as candidiasis,diabetes,herpes zoster and pulmonary tuberculosis found in some cases in steroid-treated pa- tients.Conclusion The results suggest that steroid administration with improved support care is likely to pre- vent necrotic hepatitis occurrence in patients with chronic hepatitis B of severe degree and it also shows some efficacy for chronic necrotic hepatitis B,which warrants further investigation.
出处
《热带病与寄生虫学》
2004年第2期68-74,105,共8页
Journal of Tropical Diseases and Parasitology
