Short- and long-term outcome of severe alcohol-induced hepatitis treated with steroids or enteral nutrition:: A multicenter randomized trial
Short- and long-term outcome of severe alcohol-induced hepatitis treated with steroids or enteral nutrition:: A multicenter randomized trial
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DOI：
10.1053/jhep.2000.8627
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发表时间：
2000-07-01
期刊：
影响因子：
13.5
通讯作者：
Gassull, MA
中科院分区：
文献类型：
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作者：
Cabré, E;Rodríguez-Iglesias, P;Gassull, MA
类固醇被推荐用于严重的酒精性肝炎，但一些数据表明人工营养也可能有效。我们进行了一项随机试验，比较这些患者接受全肠内营养或类固醇的短期和长期效果。共有71例患者（80%腹泻）随机接受40 mg/d泼尼松龙（n = 36）或肠道管饲（2，000 kcal/d）28天（n = 35），并随访1年或直至死亡。5例类固醇治疗患者和10例肠内营养治疗患者发生了治疗副作用（不显著）。8例肠内喂养患者提前退出试验，两组治疗期间的死亡率相似（36例中的9例与35例中的11例，意向治疗），但肠内喂养组的死亡率更早（中位数7天与23天; P = 0.025）。随访期间，类固醇组的死亡率较高（10/27 vs，2/24意向治疗; P = 0.04）。7名类固醇患者在随访的前1.5个月内死亡。与全肠内营养（TEN）相比，感染占类固醇组10例随访死亡中的9例。总之，在短期治疗重度酒精性肝炎中，肠内营养似乎并不比类固醇更糟糕，尽管肠内营养会更早发生死亡。然而，类固醇治疗与治疗后几周内的较高死亡率相关，主要是因为感染。应研究两种治疗的可能协同效应。
Steroids are recommended in severe alcohol-induced hepatitis, but some data suggest that artificial nutrition could also be effective. We conducted a randomized trial comparing the short- and long-term effects of total enteral nutrition or steroids in these patients. A total of 71 patients (80% cirrhotic) were randomized to receive 40 mg/d prednisolone (n = 36) or enteral tube feeding (2,000 kcal/d) for 28 days (n = 35), and were followed for 1 year or until death. Side effects of treatment occurred in 5 patients on steroids and 10 on enteral nutrition (not significant). Eight enterally fed patients were prematurely withdrawn from the trial, Mortality during treatment was similar in both groups (9 of 36 vs. 11 of 35, intention-to-treat) but occurred earlier with enteral feeding (median 7 vs. 23 days; P = .025). Mortality during follow-up was higher with steroids (10 of 27 vs, 2 of 24 intention-to-treat; P = .04). Seven steroid patients died within the first 1.5 months of follow-up. In contrast to total enteral nutrition (TEN), infections accounted for 9 of 10 follow-up deaths in the steroid group. In conclusion, enteral feeding does not seem to be worse than steroids in the short-term treatment of severe alcohol-induced hepatitis, although death occurs earlier with enteral nutrition. However, steroid therapy is associated with a higher mortality rate in the immediate weeks after treatment, mainly because of infections. A possible synergistic effect of both treatments should be investigated.