利用生长因子的提高生存率的失代偿期肝硬化

StephenW

SUMMARY AND COMMENT | GASTROENTEROLOGY

June 4, 2015

Use of Growth Factors Improves Survival in Decompensated Cirrhosis

Atif Zaman, MD, MPH Reviewing Kedarisetty CK et al., Gastroenterology 2015 Jun 148:1362

It also improved liver function and reduced risk for septic shock at 1-year follow-up.

Recent study findings show that granulocyte colony-stimulating factor (G-CSF) improves survival among patients with acute-on-chronic liver failure. In addition, animal studies suggest that the growth factor erythropoietin may stimulate hepatic regeneration and improve liver function. Now, investigators in India have examined the efficacy of both growth factors combined in improving survival in patients with decompensated cirrhosis.

In a double-blind trial, 55 patients with decompensated cirrhosis were randomized to receive subcutaneous G-CSF (5 µg/kg/day for 5 days and then every third day, for a total of 12 doses) plus subcutaneous darbepoetin alpha (a long-acting erythropoietin; 40 µg/week for 4 weeks) or placebo. Both groups received standard medical care and were followed for 12 months. The primary endpoint was survival at 12 months.

At the end of the 12-month follow-up, compared with the placebo group, the growth factor recipients had a higher survival rate (68.6% vs. 26.9%; P=0.003), significantly improved liver functioning (as measured by the Child-Pugh score and the model for end-stage liver disease score), and a lower rate of septic shock (6.9% vs. 38.5%; P=0.005). All patients tolerated therapy, and no discontinuations occurred.

Comment

These findings demonstrate a striking improvement in 12-month survival and liver function in patients with decompensated cirrhosis who received G-CSF and darbepoetin alpha. Some of the survival benefit was attributable to the lower rate of septic shock in these patients, which was probably due to modulation of the myeloid series in the bone marrow and improved immune function. Additional studies to validate these results are needed.

Editor Disclosures at Time of Publication

Disclosures for Atif Zaman, MD, MPH at time of publication

Nothing to disclose
   

Citation(s):

    Kedarisetty CK et al. Combination of granulocyte colony-stimulating factor and erythropoietin improves outcomes of patients with decompensated cirrhosis. Gastroenterology 2015 Jun; 148:1362. (http://dx.doi.org/10.1053/j.gastro.2015.02.054)

StephenW

总结和评论|胃肠病

2015年6月4日

利用生长因子的提高生存率的失代偿期肝硬化

与Atif扎曼博士，公共卫生硕士审查Kedarisetty CK等人，2015年消化148军：1362

它也改善肝功能，并在1年的随访风险降低为脓毒性休克。

最近的研究结果显示，粒细胞集落刺激因子（G-CSF）之间的改善患者的急性发作，慢性肝衰竭的生存。此外，动物研究表明，生长因子的红细胞生成素可刺激肝再生，改善肝功能。现在，在印度调查人员考察了生长因子相结合对提高患者的生存失代偿期肝硬化的疗效。

在双盲试验中，55名患者失代偿性肝硬化患者随机接受皮下的G-CSF（5微克/ kg /天，5天，然后每三日，共计12个剂量）加皮下达贝泊汀α（长短效促红细胞生成素; 40微克/周，连续4周）或安慰剂。两组均接受标准的医疗护理和随访12个月。主要终点是生存在12个月。

在12个月的随访结束时，与安慰剂组相比，生长因子受者有较高的存活率（68.6％对26.9％，P = 0.003），显著改善肝功能（如由子测-Pugh得分和模型终末期肝病评分），和脓毒性休克（6.9％比38.5％的较低速率，P = 0.005）。所有病人耐受治疗，没有发生停药。

评论

这些结果表明，12个月的生存和肝功能显着改善患者的失代偿期肝硬化谁收到G-CSF和达依泊汀阿尔法。一些的存活益处是由于感染性休克在这些患者中较低的速率，这可能是由于髓系列在骨髓的调制和改善免疫功能。还需要更多的研究来验证这些结果。

在发布时披露编辑

在发布时披露与Atif扎曼，MD，MPH

没有透露


引用（S）：

    Kedarisetty CK等。粒细胞集落刺激因子和促红细胞生成素的组合提高了患者的失代偿期肝硬化的成果。 2015年消化科军; 148：1362。 （http://dx.doi.org/10.1053/j.gastro.2015.02.054