Cabré E, Rodríguez-Iglesias P, Caballería J, Quer J C, Sánchez-Lombraña J L, Parés A, Papo M, Planas R, Gassull M A
Hepatology. 2000 Jul;32(1):36-42. doi: 10.1053/jhep.2000.8627.
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 Eight enterally fed patients were prematurely withdrawn from the trial.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.
对于严重酒精性肝炎，推荐使用类固醇，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，比较全肠内营养或类固醇对这些患者的短期和长期影响。总共71例患者（80%为肝硬化患者）被随机分为两组，一组接受40mg/d泼尼松龙治疗（n = 36），另一组接受肠内管饲（2000千卡/天），为期28天（n = �5），并随访1年或直至死亡。5例接受类固醇治疗的患者和10例接受肠内营养治疗的患者出现治疗副作用（无显著差异）。8例接受肠内营养的患者提前退出试验。两组治疗期间的死亡率相似（意向性治疗分析：36例中有9例，35例中有11例），但肠内营养组死亡发生得更早（中位时间分别为7天和23天；P = 0.025）。随访期间，类固醇组的死亡率更高（意向性治疗分析：27例中有10例，24例中有2例；P = 0.04）。7例接受类固醇治疗的患者在随访的前１.5个月内死亡。与全肠内营养（TEN）相比，类固醇组随访期间10例死亡中有9例是由感染导致的。总之，在严重酒精性肝炎的短期治疗中，肠内营养似乎并不比类固醇差，尽管肠内营养组死亡出现得更早。然而，类固醇治疗在治疗后的数周内死亡率较高，主要原因是感染。两种治疗方法可能的协同作用值得研究。
