糖皮质激素改善慢加急性肝衰竭前期及早期患者结局

肝脏 ›› 2025, Vol. 30 ›› Issue (1): 31-36.

糖皮质激素改善慢加急性肝衰竭前期及早期患者结局

邓茹心, 雷思贤, 孟忠吉

44200 湖北十堰市太和医院(湖北医药学院附属医院)感染科(邓茹心,雷思贤);湖北医药学院(孟忠吉)

收稿日期:2023-10-30 出版日期:2025-01-31 发布日期:2025-03-10
通讯作者: 孟忠吉, Email: zhongji.meng@163.com
基金资助:
北京肝胆相照公益基金会人工肝专项基金(RGGJJ-2021-026);2021年湖北省卫生健康委科研项目(WJ2021M051,WJ2021F037);湖北医药学院自由探索基金创新群体项目(FDFR201902),湖北医药学院研究生创新项目(YC2022038)

Glucocorticoids improve the outcomes of patients in the pre- and early stages of acute-on-chronic liver failure

DENG Ru-xin¹, LEI Si-xian¹, Meng Zhong-ji²

1. Department of Infectious, Taihe Hospital of Shiyan City, Hubei 44200, China;
2. Hubei University of Medicine, Shiyan 44200, China

Received:2023-10-30 Online:2025-01-31 Published:2025-03-10
Contact: MENG Zhong-ji, Email: zhongji.meng@163.com

摘要/Abstract

摘要： 目的研究糖皮质激素(Glucocorticoid, GC)治疗慢加急性肝衰竭(Acute-on-chronic liver failure, ACLF)前期及早期患者的临床疗效与安全性。方法回顾性分析十堰市太和医院2009年1月—2021年12月的ACLF前期及早期病例数据,根据是否使用GC治疗分为单纯标准药物治疗组(Standard medical therapy, SMT)以及糖皮质激素联合内科综合治疗组(SMT+GC)。使用倾向性评分匹配法(Propensity score matching, PSM),采用最优化匹配(Optimal)进行1∶1匹配。比较PSM匹配后的两组患者的ACLF发生率、并发症发生率及短期生存率(28 d,90 d,1年)。结果 177例ACLF前期和早期患者纳入本研究,其中SMT组132例,SMT+GC组45例。PSM匹配后的SMT+GC组与SMT组患者的基线资料无统计学差异,SMT +GC组患者的1年生存率显著高于SMT组(93.2% vs. 75.0%,P=0.020),SMT+GC组ACLF前期患者的ACLF发生率显著降低(6.66% vs.34.48%,P=0.008)。另一方面,SMT+GC和SMT在住院病程中ALT、AST和胆红素水平动态变化方面,无显著差异,但是SMT+GC组患者第7日PTA、INR改善幅度显著优于SMT组(P<0.05),SMT+GC组患者出院时病情好转率明显高于SMT组(84.4% vs. 66.4%,P=0.03)。而在并发症发生率方面SMT+GC组患者与SMT组无统计学差异(P>0.05)。结论 GC用于ACLF前期及早期患者的治疗,可以有效阻断ACLF前期患者病情进展,降低ACLF发生率,还可以提高患者的生存率,而且未增加并发症发生率。

关键词: 糖皮质激素, 慢加急性肝衰竭前期, 慢加急性肝衰竭, 治疗

Abstract: Objective To study on the clinical efficacy and safety of glucocorticoid (GC) in the treatment of patients with acute-on-chronic pre-liver failure (pre-ACLF) or acute-on-chronic liver failure in the early stage. Methods The data of patients with pre-ACLF or acute-on-chronic liver failure in the early stage hospitalized in Taihe Hospital of Shiyan City from Jan. 2009 to Dec. 2021 were retrospectively analyzed. Patients received standard medical therapy (SMT) were enrolled into a SMT group, and those received glucocorticoid (GC) based on SMT treatment were enrolled into a SMT+GC group. By using propensity score matching (PSM) method. The incidences of ACLF and complications, and short-term survival rates (28 days, 90 days, 1 year) were analyzed. Methods A total of 177 patients with pre-ACLF or ACLF in early stage were included in this study, including 132 patients in the SMT group and 45 cases in the SMT+GC group. There was no statistical difference in baseline data comparison between the SMT+GC group and SMT group after PSM matching. Compared with those who received SMT treatment only, patients received SMT+GC combination treatment showed significantly higher 1-year survival rate (93.2% vs. 75.0%, P=0.020), and in hospital improvement rate (84.4% vs. 66.4%,P=0.03). On the other hand, Prothrombin Activity (PTA), Prothrombin Time (PT), and International Normalized Ratio (INR) in SMT+GC group improved significantly on the 7th day (P<0.05). Attractively, significantly less pre-ACLF patients developed ACLF if they received SMT+GC combination treatment (6.66% vs. 34.48%, P=0.008). There was no significant difference in the incidence of complications between SMT+GC group and SMT group (P>0.05). Conclusion GC can effectively block the deterioration of patients with pre-ACLF or ACLF in early stage, especially circumvent the development of ACLF in pre-ACLF patients. It may improve the survival of patients without increasing the incidence of complications.

Key words: Glucocorticoid, Acute-on-chronic liver failure, Acute-on-chronic pre-liver failure, Treatment

邓茹心, 雷思贤, 孟忠吉. 糖皮质激素改善慢加急性肝衰竭前期及早期患者结局[J]. 肝脏, 2025, 30(1): 31-36.

DENG Ru-xin, LEI Si-xian, Meng Zhong-ji. Glucocorticoids improve the outcomes of patients in the pre- and early stages of acute-on-chronic liver failure[J]. Chinese Hepatolgy, 2025, 30(1): 31-36.

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