PDF下载 ( 168 KB)
Effects of glucocorticoids combined with antiviral therapy in treatment of patients with chronic severe hepatitis B.
-
摘要: 目的评价在抗病毒治疗的基础上应用糖皮质激素治疗早期慢性重型乙型肝炎的临床疗效。方法选取63例早期慢性重型乙型肝炎患者,随机分为治疗组33例,对照组30例,其中治疗组在综合治疗的基础上应用拉米夫定或恩替卡韦抗病毒及地塞米松等糖皮质激素治疗。对照组30例采用拉米夫定或恩替卡韦抗病毒及常规综合治疗。观察两组治疗前后的临床症状、血清总胆红素、凝血酶原活动度、HBVDNA及并发症等情况。结果8周后与对照组比较,治疗组患者血清总胆红素明显降低(P<0.05),凝血酶原活动度提升幅度大(P<0.05),肝性脑病、肝肾综合征等并发症减少(P<0.05),临床症状明显好转。4周后血清PCRHBVDNA阴转率为87.1%与对照组的85.1%相比,差异无统计学意义(P>0.05),治疗组的治疗失败率为15.2%(5/33)明显低于对照组的40.0%(12/30)(P<0.05)。结论在抗病毒治疗的基础上应用糖皮质激素对早期慢性重型乙型肝炎疗效显著,安全性好。Abstract: Objective To evaluate the clinical efficacy of glucocorticoids combined with antiviral therapy in the treatment of patients with early stage of chronic severe hepatitis B.Methods 63 patients with early stage of chronic severe hepatitis B were enrolled.33 patients in treatment group received the ordinary treatment plus dexamethasone and lamivudine/entecavir.The changes of clinical symptoms, the serum total bilirubin (TBil) , the prothrombin activities (PTA) and the serum HBVDNA levels in the 2 groups were observed before and after therapy.The side effect and complication of each group were monitored.Results After 8 weeks treatment, compared with control group, the treatment group can significantly decrease the level of TBil (P<0.05) , increase PTA level (P<0.05) , and improve the clinical symptoms.After 4 weeks treatment, the negativity of serum PCR HBVDNA was 87.1% in treatment group, it was 85.1% in control group (P>0.05) .The failure rate of the treatment group and the control group are 15.2% (5/33) and 40.0% (12/30) (P<0.05) . The complications of hepatorenal syndrome (HRS) and hepatic encephalopathy (HE) occur in control group more than that in treatment group (P<0.05) .Conclusion Glucocorticoids combined with antiviral therapy have a remarkable effect on early stage of chronic severe hepatitis B and both are very safe.
-
Key words:
- chronic hepatitis B /
- glucocorticoids /
- lamivudine /
- entecavir /
- fulminant hepatitis
-
[1]中华医学会.病毒性肝炎防治方案[J].中华传染病杂志, 2001, 19∶56-62. [2] 骆抗先.乙型肝炎基础与临床[M].第3版, 北京:人民卫生出版社, 2006∶662-665. [3]张绪清, 聂清和.糖皮质激素在治疗重型肝炎中的应用及评价[J].实用肝脏病杂志, 2004, 7 (2) ∶70-72. [4]陈从新, 刘波, 郭顺明, 等.应用糖皮质激素治疗慢性乙型肝炎重度患者阻断坏死性肝炎的发生[J].热带病与寄生虫学, 2004, 2∶68-74. [5]Chien RN, Lin CH, Liaw YF.The effect of lamivudine therapy inhepatic decompensation during acute exacerbation of chronic hepatitisB[J].Journal of Hepatology, 2003, 38 (3) ∶322-327. [6]Keiichi F, Osamu Y, Hiroshige K, et al.Importance of adequate im-munosuppressive therapy for the recovery of patients with“life-threatening”severe exacerbation of chronic hepatitis B[J].WorldJournal of Gastroenterol, 2005, 11∶1109-1114. [7]Kanda T, Yokosuka O, Imazeki F, et al.Corticosteroids and lamivu-dine combined to treat acute severe flare-up in a chronic hepatitis Band C patient[J].Journal of Gastroenterol and Hepatol, 2004, 19 (2) ∶238-239. -
本文二维码
计量
- 文章访问数: 2333
- HTML全文浏览量: 18
- PDF下载量: 816
- 被引次数: 0
下载:
