糖皮质激素和核苷类似物的早期联合治疗诱导急性肝衰竭引

StephenW

Intern Med. 2018 Jan 11. doi: 10.2169/internalmedicine.9670-17. [Epub ahead of print]
Early Combination Therapy with Corticosteroid and Nucleoside Analogue Induces Rapid Resolution of Inflammation in Acute Liver Failure Due to Transient Hepatitis B Virus Infection.Fujiwara K1, Yasui S1, Haga Y1, Nakamura M1, Yonemitsu Y1, Arai M1, Kanda T1, Oda S2, Yokosuka O1, Kato N1.
Author information
1Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan.2Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Japan.

AbstractObjective Patients with acute hepatitis B sometimes develop acute liver failure (ALF), which has a poor prognosis. The efficacy of nucleoside analogue (NA) monotherapy for ALF due to transient hepatitis B virus infection (HBV-ALF) remains controversial. Further investigations are necessary in nations with a shortage of donor livers for liver transplantation. In the present study, we aimed to clarify the efficacy of combination therapy with corticosteroid (CS) and NA in the treatment HBV-ALF. Patients We examined the clinical and biochemical features of 19 patients with HBV-ALF who were treated in the early stage of the disease between 2000 and 2015. Results Fourteen patients received CS and NA (CS + NA group) and 5 received NA monotherapy (NA group). Eleven patients (58%) survived and 8 (42%) died. The survival rates in the CS + NA and NA groups were 64% and 40%, respectively (p=0.60). The mean ALT levels declined significantly at week 2 in both groups. The mean PT activities improved significantly at weeks 1 and 2 in the CS + NA group (p<0.05) but not in the NA group. None of the surviving patients developed persistent infection. Conclusion Combination therapy with CS and NA induces the rapid resolution of inflammation leading to a rapid recovery of the liver function. When it is administered at a sufficiently early stage, it would have a survival benefit and prevent persistent infection in HBV-ALF.


KEYWORDS: acute hepatitis B; acute liver failure; combination therapy; corticosteroid; nucleoside analogue

PMID:29321429DOI:10.2169/internalmedicine.9670-17

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StephenW

实习医生2018年1月11日。doi：10.2169 / internalmedicine.9670-17。 [电子版提前打印]
糖皮质激素和核苷类似物的早期联合治疗诱导急性肝衰竭引起的急性乙型肝炎病毒感染迅速消退。
Fujiwara K1，Yasui S1，Haga Y1，Nakamura M1，Yonemitsu Y1，Arai M1，Kanda T1，Oda S2，Yokosuka O1，Kato N1。
作者信息

1
    日本千叶大学医学研究科消化内科
2
    日本千叶大学医学研究科紧急重症医学科。

抽象

目的急性乙型肝炎患者有时会出现急性肝衰竭（ALF），预后差。核苷类似物（NA）单药治疗由于短暂性乙型肝炎病毒感染（HBV-ALF）引起的ALF的功效仍有争议。肝移植供肝不足的国家需要进一步调查。在本研究中，我们旨在阐明联合使用皮质类固醇激素（CS）和NA治疗HBV-ALF的疗效。患者我们检测了2000年至2015年期间19例接受治疗的HBV-ALF患者的临床和生化特征。结果14例患者接受CS和NA（CS + NA组），5例接受NA单药治疗（NA组）。有11名患者（58％）存活，8名（42％）死亡。 CS + NA和NA组的生存率分别为64％和40％（p = 0.60）。两组平均ALT水平在第2周显着下降。在CS + NA组中，第1周和第2周的平均PT活性显着改善（p <0.05），而在NA组中不显着。幸存的患者均未发生持续性感染。结论CS，NA联合治疗能迅速消除炎症反应，使肝功能迅速恢复。当它在足够早的阶段给药时，它将具有生存益处并且防止HBV-ALF中的持续感染。
关键词：

急性乙型肝炎;急性肝衰竭;联合治疗;皮质类固醇;核苷类似物

结论：
    29321429
DOI：
    10.2169 / internalmedicine.9670-17