1. Adding methylprednisolone to standard treatment in hepatitis B virus-related acute-on-chronic liver failure was associated with an increase in 6-month survival rate.
Evidence Rating Level: 1 (Excellent)
Hepatitis B virus-related acute-on-chronic liver failure (HVB-ACLF), accounting for 70% of all ACLF cases in Asia, is a severe exacerbation of liver function leading to high mortality rates. WIth liver transplantation as the only curative treatment, there is a lack of efficacious treatment options for these patients. As systemic inflammation secondary to a cytokine storm is a key feature of ACLF, methylprednisolone (MP) has been theorized to play a role in its treatment; particularly when combined with nucleoside analogs (NAs), this combination may reverse potential HBV-related liver deterioration. However, the use of MP in HBV-ACLF remains uncertain and controversial. In this multicentre, prospective randomized controlled clinical trial, 171 patients (mean age 45.2 years, 88.9% men) with HBV-ACLF were recruited from three medical centres in Beijing. They were randomized in a 1:1 ratio to receive either MP (1.5mg/kg/day IV for 3 days, 1mg/kg/day IV for 2 days, then 0.5mg/kg/day IV for 2 days) plus standard treatment or standard treatment only (the control group). At 6 months, the mortality rate of the MP group was lower than the control group (32.4% vs 42.5%, p=0.0037), while there was no significant difference in liver transplants between the groups. The univariate analysis and collinearity diagnosis showed that MP was an independent predictor for mortality among HBV-ACLF patients (HR 0.547, p=0.040). Cox analysis identified HBV DNA and lymphocyte/monocyte ratios (LMRs) as predictors of mortality, in the MP group. In terms of adverse events, incidence of hypoalbuminemia (56.6% vs 37.5%, p=0.012), fungal infection, ascites, hepatic encephalopathy, and new onset infection (41.1% vs 31.8%, p=0.214) were higher in the MP group. While the timing of MP administration plays a major role in treatment efficacy, most patients were transferred to the medical centres after spending a median of 16 days and 20 days in primary care, in the MP and control groups respectively. As this study could not determine the significance of MP onset time, future studies should explore this factor when evaluating the potential efficacy of MP therapy in HBV-ACLF.
Click to read the study in BMC Medicine作者: StephenW 时间: 2020-12-18 09:28
1.在甲型肝炎病毒相關的慢性慢性肝衰竭的標準治療中加入甲基強的松龍與增加6個月生存率相關。
證據等級：1（優秀）
乙型肝炎病毒相關的慢性慢性肝衰竭（HVB-ACLF）佔亞洲所有ACLF病例的70％，是肝功能的嚴重惡化，導致高死亡率。儘管肝移植是唯一的治療方法，但對於這些患者缺乏有效的治療選擇。由於繼發於細胞因子風暴的全身性炎症是ACLF的一項關鍵特徵，因此已將甲基強的松龍（MP）推論為在其治療中發揮作用。特別是當與核苷類似物（NAs）結合使用時，這種結合可能會逆轉潛在的HBV相關的肝臟惡化。然而，在HBV-ACLF中使用MP仍不確定且有爭議。在這項多中心，前瞻性隨機對照臨床試驗中，從北京的三個醫療中心招募了171例HBV-ACLF患者（平均年齡45.2歲，男性88.9％）。將他們按1：1的比例隨機分配以接受MP（標準劑量為1.5mg / kg /天，靜脈注射3天，1mg / kg /天，靜脈注射2天，然後0.5mg / kg /天，靜脈注射2天）加標準治療或僅標準治療（對照組）。在6個月時，MP組的死亡率低於對照組（32.4％vs 42.5％，p = 0.0037），而兩組之間的肝移植無明顯差異。單變量分析和共線性診斷表明，MP是HBV-ACLF患者死亡率的獨立預測因子（HR 0.547，p = 0.040）。在MP組中，Cox分析確定了HBV DNA和淋巴細胞/單核細胞比率（LMR）作為死亡率的預測指標。在不良事件方面，MP組低白蛋白血症發生率（56.6％vs 37.5％，p = 0.012），真菌感染，腹水，肝性腦病和新發感染（41.1％vs 31.8％，p = 0.214）較高。 。儘管MP的給藥時間在治療效果中起著重要的作用，但在MP和對照組中，大多數患者在初級保健中花費了16天和20天的中位數後才被轉移到醫療中心。由於該研究無法確定MP發病時間的重要性，因此，未來的研究應在評估MP治療HBV-ACLF的潛在療效時探索這一因素。