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《慢性病学杂志》[ISSN:1674-8166/CN:11-5900/R]

卷:

期数:

2013年06期

页码:

433-436

栏目:

论著

出版日期:

2013-06-30

文章信息/Info

Title:

Glucocorticoids and N-acetylcysteine to treat for severe alcoholic hepatitis

作者:

张中琴

河南省鹤壁市传染病医院,河南 鹤壁 458000

Author(s):

ZHANG Zhong-qin

The Infectious Disease Hospital in Hebi,Hebi,Henan 458000,China Corresponding author:ZHANG Zhong-qin,E-mail:zzq4684@163.com

关键词:

酒精性肝炎;  治疗;  糖皮质激素;  N-乙酰半胱氨酸;  死亡率

Keywords:

Alcoholic hepatitis;  Therapy;  Glucocorticoid;  N-acetylcysteine;  Mortality

分类号:

R575.1

DOI:

-

摘要:

目的 研究糖皮质激素联合N-乙酰半胱氨酸治疗重症酒精性肝炎预后的影响。方法 178例重症酒精性肝炎患者随机分组,90例给予泼尼松龙加N-乙酰半胱氨酸,88例单纯给予泼尼松龙治疗。主要终点为6个月生存,次要终点为1个月生存和3个月生存,与N-乙酰半胱氨酸相关的不良事件,胆红素水平变化。结果 联合用药组患者死亡率未显示显著降低(6个月:27% vs 38%,P=0.07; 1个月:8% vs 24%,P=0.006; 3个月:18% vs 34%,P=0.04)死亡率有所降低。6个月肝肾综合征死亡,联合组低于单药组(9% vs 25%,P=0.03),多变量分析显示与6个月生存相关的因素包括年轻(P<0.001)、凝血酶原时间缩短(P<0.001)、基础胆红素水平较低(P<0.001)、14 d时胆红素降低(P<0.001)。联合组感染发生率较单纯激素组降低(P<0.01)。结论 虽然应用激素加N-半胱氨酸治疗重症酒精性肝炎增加1个月和3个月生存,但是6个月生存并无明显改善。

Abstract:

Objective The mortality rate of the severe acute alcoholic hepatitis is high, the outcome of severe alcoholic hepatitis can improved with glucocorticoid and N-acetylcysteine therapy. Methods A total of 178 patients with severe alcoholic hepatitis were randomly divided into two groups, 90 patients were treated with prednisolone plus N-acetylcysteine and 88 were treated with prednisolone alone.The primary end point was survival of 6 months, the secondary end point was survival of 1 months and 3 months survival, and adverse events related to N-acetylcysteine, the change of level of serum bilirubin. Results The mortality of patients in combination group did not show significantly reduced(6 months:27% to 38%,P=0.07), the mortality of 1 months(8% vs 24%,P=0.006)and 3 months(18% vs 34%,P=0.04)decreased.The hepatorenal syndrome death of 6 months combination group was lower than that of single drug group(9% vs 25%,P=0.03), The multivariate analysis showed factors related to survival at 6 months including young(P<0.001), prothrombin time(P<0.001),lower bilirubin levels(P<0.001),lower bilirubin at 14 d(P<0.001).Incidence of infection incombination group is reduced than those of the hormone group(P<0.01). Conclusions Although application of hormone and N-acetylcysteine treatment of severe alcoholic hepatitis may increased 1 and 3 months survival, but 6 months survival was not significantly improved.

参考文献/References:

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备注/Memo

备注/Memo:

作者简介:张中琴,本科,主治医师,主要从事传染病治疗工作 通讯作者:张中琴,E-mail:zzq4684@163.com

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更新日期/Last Update: 2013-06-30