Chen Jun-Feng, Wang Ke-Wei, Zhang Shao-Quan, Lei Zi-Ying, Xie Jun-Qiang, Zhu Jian-Yun, Weng Wei-Zhen, Gao Zhi-Liang, Lin Bing-Liang
Department of Infectious Diseases, Third Affiliated Hospital of Sun Yet-Sen University, Guangzhou, Guangdong Province, China; Key Laboratory of Tropical Disease Control, Sun Yat-Sen University, Ministry of Education, Guangzhou, Guangdong Province, China.
J Gastroenterol Hepatol. 2014 Apr;29(4):800-6. doi: 10.1111/jgh.12454.
Acute-on-chronic liver failure (ACLF) caused by hepatitis B virus (HBV) is a severe disease with high mortality. Immune injury plays an important role during the early stage of the disease. Our research aimed to investigate the safety and efficacy of dexamethasone therapy for patients with HBV-related ACLF.
A total of 134 inpatients with HBV-induced ACLF were enrolled from January 2009 to December 2012. All the patients received the standard medicine treatment (SMT), among whom 31 cases underwent additional dexamethasone injection for three times (dexamethasone treatment [DMT] Group). A total of 35 patients (SMT Group) matched for baseline characters served as controls. Both the groups were followed up for 12 weeks. The survival rates, liver functions, and complications were recorded.
The 12-week cumulative survival rates were 45.7% (16/35)and 48.4% (15/31) for SMT Group and DMT Group, respectively, and no significant differences were found (P = 0.959). There were no dramatic differences in liver function and model for end-stage liver disease (MELD) score at 1, 2, 4, 8, and 12 weeks between two groups. There were no significant differences in the incidence of complications (i.e. infection, gastrointestinal bleeding, encephalopathy, hepatorenal syndrome, and ascites) from 1 to 12 weeks between Group SMT and Group DMT. More than 40 ages, MELD score more than 28 and encephalopathy were independent risk factors for the mortality of patients.
Dexamethasone cannot improve liver functions and 12-week survival rates of patients with HBV-related ACLF. Age, MELD score, and encephalopathy are independent risk factors.
乙型肝炎病毒（HBV）所致的慢加急性肝衰竭（ACLF）是一种死亡率很高的严重疾病。免疫损伤在疾病早期起着重要作用。我们的研究旨在探讨地塞米松治疗HBV相关ACLF患者的安全性和疗效。
2009年1月至2012年12月共纳入134例HBV所致ACLF住院患者。所有患者均接受标准药物治疗（SMT），其中31例额外接受3次地塞米松注射（地塞米松治疗[DMT]组）。选取35例基线特征匹配的患者（SMT组）作为对照。两组均随访12周。记录生存率、肝功能和并发症情况。
SMT组和DMT组12周累积生存率分别为45.7%（16/35）和48.4%（15/31），差异无统计学意义（P = 0.959）。两组在1、2、4、8和12周时肝功能和终末期肝病模型（MELD）评分无显著差异。SMT组和DMT组在1至12周并发症（即感染、消化道出血、肝性脑病、肝肾综合征和腹水）发生率方面无显著差异。年龄大于40岁、MELD评分大于28分和肝性脑病是患者死亡的独立危险因素。
地塞米松不能改善HBV相关ACLF患者的肝功能和12周生存率。年龄、MELD评分和肝性脑病是独立危险因素。
