el-Zayadi A, Mohran Z, Hasseeb N, Nagy N, Dabbous H
Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Am J Gastroenterol. 1991 Jan;86(1):53-6.
The aim of this work was to evaluate the effect of short-term corticosteroids in resistant ascites complicating schistosomal liver disease after 4 wk or more on standard treatment. Thirty-seven patients were randomly allocated to two groups: Group I (18 patients) was put on 40 mg furosemide and 200 mg spironolactone, in addition to a 15-day, tapering dose of prednisone (15, 10, 5 mg). Group II (19) patients received the same diuretics without steroids, and served as controls. At the end of a 2-wk course of therapy, the mean variations were as follows: body weight in patients in Group I ("cases") decreased by 9.8 kg, compared with 4.3 kg in controls; abdominal girth decreased by 7.4 cm in cases, compared with 3.6 cm in controls; urine output increased by 635.9 ml in cases, compared with 364.6 ml in controls; urinary sodium excretion increased by 16.5 mEq/day in cases, compared with 4.1 mEq/day in controls. These differences between cases and controls were found to be statistically significant (p less than 0.01). On the other hand, there were insignificant differences as regards decrease in blood urea (3.2 g/dl for cases and 2.7 g/dl for controls), decrease in serum creatinine (0.2 mg/dl for both cases and controls), increase in serum albumin (0.3 g/dl in cases and 0.2 g/dl in controls), increase in serum sodium (3.2 mEq/L in cases and 2.7 mEq/L in controls), and increase in serum potassium (0.2 mEq/L in cases and 0.4 mEq/L in controls). We conclude that a short-term course of corticosteroids in conjunction with standard diuretics has proved to be an effective, safe, and economical modality to relieve resistant hepatic ascites. It can be considered a temporary alternative to paracentesis with albumin infusion.
这项研究的目的是评估短期使用皮质类固醇对标准治疗4周或更长时间后并发血吸虫性肝病的顽固性腹水的影响。37例患者被随机分为两组：第一组（18例患者）除服用15天逐渐减量的泼尼松（15、10、5毫克）外，还服用40毫克速尿和200毫克螺内酯。第二组（19例）患者服用相同的利尿剂但不使用类固醇，作为对照组。在为期2周的治疗过程结束时，平均变化如下：第一组（“病例组”）患者体重下降9.8千克，而对照组下降4.3千克；病例组腹围减少7.4厘米，对照组减少3.6厘米；病例组尿量增加635.9毫升，对照组增加364.6毫升；病例组尿钠排泄量增加16.5毫当量/天，对照组增加4.1毫当量/天。病例组与对照组之间的这些差异具有统计学意义（p小于0.01）。另一方面，在血尿素降低（病例组为3.2克/分升，对照组为2.7克/分升）、血清肌酐降低（病例组和对照组均为0.2毫克/分升）、血清白蛋白增加（病例组为0.3克/分升，对照组为0.2克/分升）、血清钠增加（病例组为3.2毫当量/升，对照组为2.7毫当量/升）以及血清钾增加（病例组为0.2毫当量/升，对照组为0.4毫当量/升）方面，差异不显著。我们得出结论，短期使用皮质类固醇联合标准利尿剂已被证明是缓解顽固性肝腹水的一种有效、安全且经济的方式。它可被视为腹腔穿刺放液并输注白蛋白的一种临时替代方法。
