利福昔明治疗肝衰竭及其并发症的疗效分析

肝脏 ›› 2025, Vol. 30 ›› Issue (1): 37-41.

利福昔明治疗肝衰竭及其并发症的疗效分析

张莉, 卞兆连, 田李均, 刘一村, 陈伟杰, 薛红

226001 江苏南通大学医学院,南通市第三人民医院/南通大学附属南通第三医院(张莉,刘一村,陈伟杰);南通大学附属南通第三医院/南通市第三人民医院消化内科(卞兆连), 重症医学科(田李均), 肝病科(薛红)

收稿日期:2023-11-30 出版日期:2025-01-31 发布日期:2025-03-10
通讯作者: 薛红,Email:xuehong1981@126.com

An analysis on the treatment effect of rifaximin on liver failure and its complications

ZHANG Li¹, BIAN Zhao-lian², TIAN Li-jun³, LIU Yi-cun¹, CHEN Wei-jie¹, XUE Hong⁴

1. Nantong University School of Medicine, Jiangsu 226001, China;
2. Nantong University Affiliated Nantong Third Hospital/Nantong Third People's Hospital, Department of Gastroenterology, Nantong University Affiliated Nantong Third Hospital/Nantong Third People's Hospital, Jiangsu 226006, China;
3. Department of Intensive Care Medicine, Nantong 226006;
4. Department of Hepatology, Nantong University Affiliated Nantong Third Hospital/Nantong Third People's Hospital, Jiangsu 226006, China

Received:2023-11-30 Online:2025-01-31 Published:2025-03-10
Contact: XUE Hong, Email:xuehong1981@126.com

摘要/Abstract

摘要： 目的探讨利福昔明对肝衰竭(liver failure, LF)及其并发症的影响及疗效评估。方法回顾性地收集并分析2020年1月—2022年10月在南通市第三人民医院诊治的75例肝衰竭患者的临床资料。在内科综合治疗及部分人工肝支持的基础上,根据有无使用利福昔明治疗将患者分成利福昔明组和对照组,利福昔明组在对照组基础上给予利福昔明400 mg,每日3次,疗程3个月。记录两组患者入院时并发症(感染、肝性脑病、腹水)的发生情况以及随访期间并发症的好转情况;根据随访90 d时患者的生存状态,绘制Kaplan-Meier生存曲线比较两组患者90 d的生存率。结果两组间年龄、性别、人工肝、CTP评分及MELD评分等差异无统计学意义(P>0.05);经过3个月的规律治疗,利福昔明组的感染好转率高于对照组(77.8% vs. 44.4%,P=0.020)、肝性脑病(Hepatic encephalopathy, HE)好转率高于对照组(88.9% vs. 37.5%,P=0.013)、腹水好转率高于对照组(62.5% vs. 31.2%,P=0.038),差异均有统计学意义(P<0.05);Kaplan-Meier分析显示利福昔明组的肝衰竭患者90 d生存率[36.0% (9/25)]高于对照组率[16.0% (8/50)](P<0.05)。结论在LF患者中,利福昔明治疗显著改善感染、HE以及腹水的并发症,有利于延长肝衰竭患者的生存期,证明了利福昔明在肝衰竭及其并发症的治疗中具有一定的可行性。

关键词: 利福昔明, 肝衰竭, 并发症, 肠道菌群, 疗效

Abstract: Objective To investigate the treatment effect of rifaximin on liver failure (LF) and its complications. Methods The clinical data of 75 patients with liver failure treated at the Third People's Hospital of Nantong City from January 2020 to October 2022 were retrospectively analyzed. On the basis of comprehensive medical treatment and partial artificial liver support, patients were divided into a rifaximin group and a control group according to the presence or absence of rifaximin treatment. The patients in rifaximin group were given rifaximin 400 mg three times daily for 3 months on top of the treatment of control group. The occurrence of complications (i.e., infection, hepatic encephalopathy, ascites) at the time of admission and the improvement of complications during the follow-up period were recorded in both groups; Kaplan-Meier survival curves were plotted to compare the 90-day survival rates of the two groups according to the survival status of patients at 90 days of follow-up. Methods There were no statistically significant differences in age, sex, artificial liver, Child-Turcotte-Pugh (CTP) score and Model for End-Stage Liver Disease (MELD) score between the two groups (P>0.05); after 3 months of regular treatment, the rate of improvement of infection was higher in the rifaximin group than in the control group (77.8% vs. 44.4%, P=0.020), and the rate of improvement of hepatic encephalopathy (HE) was higher than that in the (88.9% vs. 37.5%, P=0.013) and ascites (62.5% vs. 31.2%, P=0.038), all statistically significant (P<0.05); Kaplan-Meier analysis showed that the 90-day survival rate of patients with liver failure in the rifaximin group [36.0% (9/25)] was higher than that in the control group [16.0% (8/50)] (P<0.05). Conclusion In patients with liver failure, rifaximin treatment significantly improved the complications of infection, Hepatic Encephalopathy (HE), and ascites, and helped prolong the survival of patients, demonstrating the feasibility of rifaximin in the treatment of liver failure and its complications.

Key words: Rifaximin, Liver failure, Complications, Intestinal microbiota, Efficacy

张莉, 卞兆连, 田李均, 刘一村, 陈伟杰, 薛红. 利福昔明治疗肝衰竭及其并发症的疗效分析[J]. 肝脏, 2025, 30(1): 37-41.

ZHANG Li, BIAN Zhao-lian, TIAN Li-jun, LIU Yi-cun, CHEN Wei-jie, XUE Hong. An analysis on the treatment effect of rifaximin on liver failure and its complications[J]. Chinese Hepatolgy, 2025, 30(1): 37-41.

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参考文献

[1] YeC, Li W, Li L, et al. Glucocorticoid Treatment Strategies in Liver Failure[J]. Front Immunol,2022,13:846091.
[2] ZaccheriniG, Weiss E, Moreau R. Acute-on-chronic liver failure: Definitions, pathophysiology and principles of treatment[J]. JHEP Rep,2021,3(1):100176.
[3] WangK, Zhang Z, Mo Z S, et al. Gut microbiota as prognosis markers for patients with HBV-related acute-on-chronic liver failure[J]. Gut microbes,2021,13(1):1-15.
[4] TilgH, Adolph T E, Trauner M. Gut-liver axis: Pathophysiological concepts and clinical implications[J]. Cell Metab,2022,34(11):1700-1718.
[5] 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志,2019,35(01):38-44.
[6] TrépoE, Goossens N, Fujiwara N, et al. Combination of Gene Expression Signature and Model for End-Stage Liver Disease Score Predicts Survival of Patients With Severe Alcoholic Hepatitis[J]. Gastroenterology,2018,154(4):965-975.
[7] AntunesA G, Teixeira C, Vaz A M, et al. Comparison of the prognostic value of Chronic Liver Failure Consortium scores and traditional models for predicting mortality in patients with cirrhosis[J]. Gastroenterol Hepatol,2017,40(4):276-285.
[8] BurraP, Samuel D, Sundaram V, et al. Limitations of current liver donor allocation systems and the impact of newer indications for liver transplantation[J]. J Hepatol,2021,75 Suppl 1(S178-S190).
[9] AdakA, Khan M R. An insight into gut microbiota and its functionalities[J]. Cell Mol Life Sci,2019,76(3):473-493.
[10] Vespasiani-GentilucciU, Carotti S, Perrone G, et al. Hepatic toll-like receptor 4 expression is associated with portal inflammation and fibrosis in patients with NAFLD[J]. Liver Int,2015,35(2):569-581.
[11] ZengX, Sheng X, Wang P Q, et al. Low-dose rifaximin prevents complications and improves survival in patients with decompensated liver cirrhosis[J]. Hepatol Int,2021,15(1):155-165.
[12] ChenY, Guo J, Qian G, et al. Gut dysbiosis in acute-on-chronic liver failure and its predictive value for mortality[J]. J Gastroenterol Hepatol,2015,30(9):1429-1437.
[13] 李兰娟, 吴仲文, 马伟杭, 等. 慢性重型肝炎患者肠道菌群的变化[J]. 中华传染病杂志,2001,06):24-26.
[14] 徐萌, 孙凤霞, 李杰, 等. 肠道菌群调节在非酒精性脂肪性肝病中西医治疗中的研究进展[J]. 临床肝胆病杂志,2020,36(06):1378-1381.
[15] NakamuraK, Kageyama S, Ito T, et al. Antibiotic pretreatment alleviates liver transplant damage in mice and humans[J]. J Clin Invest,2019,129(8):3420-3434.
[16] BertuzzoV R, Giannella M, Cucchetti A, et al. Impact of preoperative infection on outcome after liver transplantation[J]. Br J Surg, 2017,104(2):e172-e181.
[17] BellafanteD, Gioia S, Faccioli J, et al. Old and New Precipitants in Hepatic Encephalopathy: A New Look at a Field in Continuous Evolution[J]. J Clin Med,2023,12(3):1187.
[18] PatelV C, Lee S, Mcphail M J W, et al. Rifaximin-α reduces gut-derived inflammation and mucin degradation in cirrhosis and encephalopathy: RIFSYS randomised controlled trial[J]. J Hepatol,2022,76(2):332-342.
[19] LuoM, Xin R J, Hu F R, et al. Role of gut microbiota in the pathogenesis and therapeutics of minimal hepatic encephalopathy via the gut-liver-brain axis[J]. World J Gastroenterol,2023,29(1):144-156.
[20] JiménezC, Ventura-Cots M, Sala M, et al. Effect of rifaximin on infections, acute-on-chronic liver failure and mortality in alcoholic hepatitis: A pilot study (RIFA-AH)[J]. Liver Int,2022,42(5):1109-1120.
[21] KajiK, Takaya H, Saikawa S, et al. Rifaximin ameliorates hepatic encephalopathy and endotoxemia without affecting the gut microbiome diversity[J]. World J Gastroenterol,2017,23(47):8355-8366.
[22] KajiK, Saikawa S, Takaya H, et al. Rifaximin Alleviates Endotoxemia with Decreased Serum Levels of Soluble CD163 and Mannose Receptor and Partial Modification of Gut Microbiota in Cirrhotic Patients[J]. Antibiotics (Basel),2020,9(4):145.
[23] KamalF, Khan M A, Khan Z, et al. Rifaximin for the prevention of spontaneous bacterial peritonitis and hepatorenal syndrome in cirrhosis: a systematic review and meta-analysis[J]. Eur J Gastroenterol Hepatol,2017,29(10):1109-1117.
[24] KangS H, Lee Y B, Lee J H, et al. Rifaximin treatment is associated with reduced risk of cirrhotic complications and prolonged overall survival in patients experiencing hepatic encephalopathy[J]. Aliment Pharmacol Ther,2017,46(9):845-855.