Importance of adequate immunosuppressive therapy for the recovery of patients with "life-threatening" severe exacerbation of chronic hepatitis B
Importance of adequate immunosuppressive therapy for the recovery of patients with "life-threatening" severe exacerbation of chronic hepatitis B
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DOI：
10.3748/wjg.v11.i8.1109
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发表时间：
2005-02-28
影响因子：
4.3
通讯作者：
Suzuki, Hiroshi
中科院分区：
文献类型：
--
作者：
Fujiwara, Keiichi;Yokosuka, Osamu;Suzuki, Hiroshi
目的：慢性B型肝炎患者中，B型肝炎病毒（HBV）的再激活通常自发发生或在免疫抑制治疗停止后发生。严重恶化，有时发展为爆发性肝衰竭，死亡风险很高。皮质类固醇治疗慢性B型肝炎“临床重度”恶化的疗效尚未得到充分证实。在这项研究中，我们评估了早期引入高剂量皮质类固醇治疗危及生命的慢性B型肝炎严重急性发作的患者的疗效。方法：22例患者，14名男性和8名女性，被定义为“严重”的慢性B型肝炎急性发作使用统一的标准，并参加了这项研究。11例患者在确诊为严重疾病后10 d内接受糖皮质激素治疗，剂量为每日60 mg或以上，同时或不同时使用抗病毒药物（“早期高剂量”组）和11例患者要么治疗超过10天，要么未经皮质类固醇治疗（“非早期高剂量”组）。平均年龄、男女比例、平均凝血酶原时间（PT）活性、丙氨酸转氨酶（ALT）水平、总胆红素水平、HBeAg阳性、平均IgM-HBc滴度，平均HBV DNA聚合酶活性在两组之间没有差异。“早期高剂量”组11例中有10例存活，而“非早期高剂量”组11例中只有2例存活（P
AIM: Hepatitis B virus (HBV) re-activation often occurs spontaneously or after withdrawal of immunosuppressive therapy in patients with chronic hepatitis B. Severe exacerbation, sometimes developing into fulminant hepatic failure, is at high risk of mortality. The efficacy of corticosteroid therapy in "clinically severe" exacerbation of chronic hepatitis B has not been well demonstrated. In this study we evaluated the efficacy of early introduction of high-dose corticosteroid therapy in patients with life-threatening severe exacerbation of chronic hepatitis B.METHODS: Twenty-two patients, 14 men and 8 women, were defined as "severe" exacerbation of chronic hepatitis B using uniform criteria and enrolled in this study. Eleven patients were treated with corticosteroids at 60 mg or more daily with or without anti-viral drugs within 10 d after the diagnosis of severe disease ("early high-dose" group) and 11 patients were either treated more than 10 d or untreated with corticosteroids ("non-early high-dose" group).RESULTS: Mean age, male-to-female ratio, mean prothrombin time (PT) activity, alanine transaminase (ALT) level, total bilirubin level, positivity of HBeAg, mean IgM-HBc titer, and mean HBV DNA polymerase activity did not differ between the two groups. Ten of 11 patients of the "early high-dose" group survived, while only 2 of 11 patients of the "non-early high-dose" group survived (P