Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids
Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids
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DOI：
10.1016/j.jhep.2007.10.010
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发表时间：
2008-03-01
影响因子：
25.7
通讯作者：
Mathurin, Philippe
中科院分区：
文献类型：
--
作者：
Louvet, Alexandre;Diaz, Emmanuel;Mathurin, Philippe
背景/目的：在重度酒精性肝炎（AH）中，40%的患者不能从皮质类固醇中获益。需要改善对无应答者的管理，只有喷替茶碱可被视为替代药物。评估了两步策略，包括早期停用皮质类固醇，并在使用胆红素水平早期变化确定的无应答者中改用戊茶碱额外28天。121例AH患者前瞻性接受皮质类固醇治疗，并对29例按照两步策略治疗的无应答者提出两步策略，并与58例匹配的无应答者进行比较。结果：两组患者的临床和生物学特征相似。与对照组相比，接受两步策略治疗的患者在2个月时的生存率没有改善：35.5 +/- 6.3% vs 31 +/-8.6%。21天后，凝血酶原时间（-0.25 s vs +0.2 s）、胆红素（0.8 mg/dl vs 2.03 mg/dl）和肌酐（+0.16 mg/dl vs -0.7 mg/dl）的生物学演变相似。在多变量分析中，只有年龄，胆红素的演变在第一周，肌酐和DF与2个月survival.Conclusions：无反应的皮质类固醇没有获得任何好处，从早期切换到penglovifylline。因此，无应答者的管理问题仍未得到解决。(C)2007年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Background/Aims: In severe alcoholic hepatitis (AH), 40% of patients will obtain no benefit from corticosteroids. Improvement in management of non-responders is warranted and only pentoxifylline can be considered an alternative. A two-step strategy was evaluated consisting of early withdrawal of corticosteroids and a switch to pentoxifylline for 28 additional days in non-responders identified using early change in bilirubin level.Methods: One hundred and twenty-one patients with AH were treated prospectively with corticosteroids, and the two-step strategy was proposed to 29 non-responders treated according to a two-step strategy who were compared to 58 matched non-responders treated with corticosteroids only.Results: Clinical and biological features of the two groups were similar. There was no survival improvement at 2 months in patients treated with the two-step strategy compared to controls: 35.5 +/- 6.3% vs 31 +/- 8.6%. After 21 days, biological evolution was similar for prothrombin time (-0.25 s vs +0.2 s), bilirubin (0.8 mg/dl vs 2.03 mg/dl) and creatinine (+0.16 mg/dl vs -0.7 mg/dl). In multivariate analysis, only age, evolution of bilirubin during the first week, creatinine and DF were associated with 2-month survival.Conclusions: Non-responders to corticosteroids do not obtain any benefit from an early switch to pentoxifylline. Thus, the issue of management of non-responders remains unresolved. (C) 2007 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.