Survival and prognostic factors in patients with severe alcoholic hepatitis treated with prednisolone
Survival and prognostic factors in patients with severe alcoholic hepatitis treated with prednisolone
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DOI：
10.1053/gast.1996.v110.pm8964410
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发表时间：
1996-06-01
期刊：
影响因子：
29.4
通讯作者：
Poynard, T
中科院分区：
文献类型：
--
作者：
Mathurin, P;Duchatelle, V;Poynard, T
背景和目的：皮质类固醇已被证明可显着降低严重酒精性肝炎患者的短期死亡率，然而，与良好结果和长期生存相关的独立因素尚不清楚，本研究的目的是检查活检证实的严重酒精性肝炎患者的预后因素和长期生存，方法：在研究的 183 名患者中，61 名在之前的试验中被随机分配；其中 32 人接受泼尼松龙治疗（I 组），29 人未接受治疗（II 组）； 61 名患者从本次随机试验结束后接受治疗（第 III 组）；模拟了 61 名和 61 名患者（第 IV 组），结果：1 年时，第 1 组（69%；置信区间 [CI]，57%-81%）和第 III 组（71%；CI，55%-87%）的生存率优于未治疗组（第 II 组，41%；CI，23%-59%；P = 0.01）（第 IV 组，50%；CI， 37%-63%；P = 0.05)。 2 年时，生存率没有显着差异。肝脏多形核浸润明显的治疗患者的 1 年生存率 (76%; CI, 64%-88%) 优于其他患者 (53%; CI, 35%-71%; P = 0.05)，多形核计数 > 5500/mm(3) 的治疗患者的 1 年生存率 (77%; CI, 65%-89%) 优于其他患者(40%; CI, 14%-66%; P = 0.003)，在 93 名接受治疗的患者中，肝脏多形核浸润 (P < 0.03) 和多形核计数 (P < 0.001) 与 1 年生存率独立相关，结论：泼尼松龙使死亡率至少降低 1 年，肝脏多形核浸润和多形核计数是独立的预后因素。
Background & Aims: Corticosteroids have been shown to significantly decrease short-term mortality in patients with severe alcoholic hepatitis, However, independent factors associated with a favorable outcome and long-term survival are unknown, The aim of this study was to examine prognostic factors and long-term survival in patients with biopsy-proven severe alcoholic hepatitis, Methods: Of 183 patients studied, 61 had been randomized in a previous trial; 32 of them were treated with prednisolone (group I) and 29 were not treated (group II); 61 were treated from the end of this randomized trial (group III); and 61 were simulated (group IV), Results: At 1 year, survival in group 1 (69%; confidence interval [CI], 57%-81%) and group III (71%; CI, 55%-87%) was better than in the nontreated groups (group II, 41%; CI, 23%-59%; P = 0.01) (group IV, 50%; CI, 37%-63%; P = 0.05). At 2 years, survival was not significantly different. Treated patients with marked liver polymorphonuclear infiltrate had better 1-year survival (76%; CI, 64%-88%) than the others (53%; CI, 35%-71%; P = 0.05), Treated patients with polymorphonuclear counts of >5500/mm(3) had better 1-year survival (77%; CI, 65%-89%) than the others (40%; CI, 14%-66%; P = 0.003), In the 93 treated patients, liver polymorphonuclear infiltrate (P < 0.03) and polymorphonuclear count (P < 0.001) were independently correlated with 1-year survival, Conclusions: Prednisolone reduced mortality by at least 1 year, Liver polymorphonuclear infiltrate and polymorphonuclear count were independent prognostic factors.