Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China.
Hepatol Res. 2011 Jan;41(1):46-53. doi: 10.1111/j.1872-034X.2010.00740.x. Epub 2010 Oct 25.
Acute-on-chronic pre-liver failure (pre-ACLF) is defined as a severe acute episode of chronic hepatitis B characterized by serum bilirubin of 171 µmol/L or more, alanine aminotransferase of five times or more the upper limit of normal and prothrombin activity of more than 40%, having a potential for progression to acute-on-chronic liver failure (ACLF). This study is to evaluate the efficacy of short-term dexamethasone in pre-ACLF.
One hundred and seventy patients were assigned to dexamethasone therapy and control group at a ratio of 1:2. For the two groups, we compared biochemical indicators, the incidence of ACLF and mortality. The influential factors on the mortality of patients with pre-ACLF were studied by Cox proportional hazards models.
The significantly lower incidence of ACLF and higher survival rate were observed in patients on dexamethasone therapy (8.9%, 96.4%, respectively) than in control patients (70.2%, 52.6%, respectively; P < 0.001). Dexamethasone treatment was an independent factor influencing the survival rate (P < 0.001, odds ratio = 0.055, 95% confidence interval = 0.013-0.225). During 4 weeks of treatment, serum bilirubin levels of survival patients were significantly lower in the dexamethasone group than control group.
Five-day dexamethasone therapy is effective in improving the liver function and survival rate of patients with pre-ACLF.
慢加急性肝衰竭前期（pre-ACLF）定义为慢性乙型肝炎的严重急性发作，其特征为血清胆红素>171 μmol/L，丙氨酸氨基转移酶（ALT）≥正常上限的 5 倍，凝血酶原活动度（PTA）>40%，有进展为慢加急性肝衰竭（ACLF）的潜在风险。本研究旨在评估短期应用地塞米松治疗 pre-ACLF 的疗效。
将 170 例患者按 1:2 的比例分为地塞米松治疗组和对照组。比较两组患者的生化指标、ACLF 发生率和死亡率。采用 Cox 比例风险模型研究影响 pre-ACLF 患者死亡率的因素。
地塞米松治疗组 ACLF 发生率（8.9%）明显低于对照组（70.2%），生存率（96.4%）明显高于对照组（52.6%）（P<0.001）。地塞米松治疗是影响生存率的独立因素（P<0.001，比值比=0.055，95%置信区间=0.013-0.225）。在 4 周治疗期间，生存患者的血清胆红素水平在地塞米松组明显低于对照组。
5 天的地塞米松治疗可有效改善 pre-ACLF 患者的肝功能和生存率。
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