Department of Gastroenterology and Nephrology, Chiba University, Chiba, Japan.
Hepatol Res. 2014 May;44(5):491-501. doi: 10.1111/hepr.12148. Epub 2013 May 22.
Acute liver failure (ALF) is a worldwide problem despite its rare incidence because of its extremely high mortality. There are no beneficial therapies except for emergency liver transplantation for ALF. However, in Japan where the problem of a shortage of donor livers still remains, therapies other than transplantation must be further investigated for patients with ALF. Our aim was to elucidate the efficacy of high-dose corticosteroid (CS) in decreasing liver enzyme levels in the early stage of ALF.
Thirty-one consecutive Japanese patients with viral ALF in the early stage were prospectively examined for their clinical and biochemical features and treatment responses during 2 weeks after the start of treatment. Nineteen were treated with high-dose methylprednisolone, and 12 having clinical and biochemical backgrounds with no significant difference were treated without CS.
The aspartate aminotransferase : alanine aminotransferase ratio became lower in patients treated with CS than in controls (P < 0.05). Fifteen of 19 patients in the CS group and eight of 12 in the control group recovered (P = 0.36). Hepatitis B viral infection and advanced liver damage at the start of treatment were associated with poor prognosis (P < 0.05). Complications during the therapy were not greater in the CS group than control (P = 0.64).
The introduction of high-dose CS in the early stage of ALF was effective in suppressing the destruction of hepatocytes. CS-treated patients showed slightly higher survival rates and slightly more improved liver regeneration than controls, although the differences were not statistically significant.
尽管急性肝衰竭（ALF）的发病率很低，但由于其极高的死亡率，它仍是一个全球性问题。除了紧急肝移植，ALF 没有其他有益的治疗方法。然而，在日本，供体肝脏短缺的问题仍然存在，因此必须进一步研究除移植以外的治疗方法，以治疗 ALF 患者。我们的目的是阐明大剂量皮质类固醇（CS）在降低 ALF 早期肝酶水平方面的疗效。
31 例连续的日本病毒性 ALF 早期患者前瞻性地检查了他们的临床和生化特征以及治疗开始后 2 周内的治疗反应。19 例患者接受大剂量甲基强的松龙治疗，12 例具有无明显差异的临床和生化背景的患者未接受 CS 治疗。
与对照组相比，接受 CS 治疗的患者天冬氨酸转氨酶：丙氨酸转氨酶比值降低（P<0.05）。CS 组 19 例患者中的 15 例和对照组 12 例中的 8 例恢复（P=0.36）。治疗开始时乙型肝炎病毒感染和严重的肝损伤与不良预后相关（P<0.05）。CS 组与对照组相比，治疗期间的并发症没有增加（P=0.64）。
在 ALF 的早期阶段引入大剂量 CS 可有效抑制肝细胞的破坏。CS 治疗组的患者的生存率略高，肝再生略好，尽管差异无统计学意义。
