Sequential therapy consisting of glucocorticoid infusions followed by granulocyte-monocyte absorptive apheresis in patients with severe alcoholic hepatitis
Sequential therapy consisting of glucocorticoid infusions followed by granulocyte-monocyte absorptive apheresis in patients with severe alcoholic hepatitis
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DOI：
10.1007/s00535-016-1287-9
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发表时间：
2017-07-01
影响因子：
6.3
通讯作者：
Mochida, Satoshi
中科院分区：
文献类型：
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作者：
Watanabe, Kazuhiro;Uchida, Yoshihito;Mochida, Satoshi
背景：浸润肝脏的活化白细胞有助于酒精性肝炎的激发。糖皮质激素诱导白细胞从肝窦中脱边，而粒细胞-单核细胞吸收性单采术（GMA）从循环中清除白细胞。因此，有用的序贯治疗组成的糖皮质激素输注，然后GMA在重度酒精性hepatitis.Methods患者严重酒精性hepatitis接受静脉注射甲基强的松龙（1,000 mg/天）3或4天，然后GMA进行每天3天。应答者被定义为那些衰减的血清C-反应蛋白（CRP）水平在GMA programmes.Results连续10例患者入选。在基线时，2名患者的日本酒精性肝炎评分为9分，8名患者为10分或以上，终末期肝病模型评分范围为22至43分。在所有患者中，外周中性粒细胞计数增加，CRP，天冬氨酸氨基转移酶，IL-6，IL-8，TNF-α和细胞间粘附分子1的血清水平在糖皮质激素输注后立即下降。然而，在停止糖皮质激素输注后，在所有患者中观察到血清CRP水平的反弹性升高，但GMA程序期间的最大值低于基线值。6例患者获救，而其余4例患者死亡，因为脓毒症，肺炎，胰腺炎，和renal failure.Conclusions序贯治疗结合糖皮质激素输注和GMA是有用的，以减轻肝损伤的严重酒精性肝炎患者，通过防止反弹增加炎症反应后停止糖皮质激素输注，除了细菌感染和/或多器官功能衰竭的患者。
Background Activated leukocytes infiltrating the liver contribute to the provocation of alcoholic hepatitis. Glucocorticoid induces the demargination of leukocytes from the hepatic sinusoids, whereas granulocyte-monocyte absorptive apheresis (GMA) removes leukocytes from the circulation. Thus, the usefulness of a sequential therapy consisting of glucocorticoid infusions followed by GMA was evaluated in patients with severe alcoholic hepatitis.Methods Patients with severe alcoholic hepatitis received intravenous injections of methylprednisolone (1,000 mg/day) for 3 or 4 days, and then GMA was performed every day for 3 days. Responders were defined as those with attenuated serum C-reactive protein (CRP) levels during the GMA procedures.Results Ten consecutive patients were enrolled. At the baseline, the Japan alcoholic hepatitis scores were 9 in two patients and 10 or more in eight patients, and the Model for End-Stage Liver Disease scores ranged from 22 to 43. In all the patients, the peripheral neutrophil counts increased and the serum levels of CRP, aspartate aminotransferase, IL-6, IL-8, TNF-alpha, and intercellular adhesion molecule 1 decreased immediately after the glucocorticoid infusions. However, a rebound increase in the serum CRP levels was observed in all patients after discontinuation of glucocorticoid infusions, but the maximal values during the GMA procedures were lower than the baseline values. Six patients were rescued, whereas the remaining four patients died because of sepsis, pneumonia, pancreatitis, and renal failure.Conclusions Sequential therapy combining glucocorticoid infusion and GMA was useful for attenuating liver injuries in patients with severe alcoholic hepatitis by preventing rebound increases in inflammatory reactions after discontinuation of glucocorticoid infusions, except in patients with bacterial infections and/or multiple organ failure.