Kang S H, Lee Y B, Lee J-H, Nam J Y, Chang Y, Cho H, Yoo J-J, Cho Y Y, Cho E J, Yu S J, Kim M Y, Kim Y J, Baik S K, Yoon J-H
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Aliment Pharmacol Ther. 2017 Nov;46(9):845-855. doi: 10.1111/apt.14275. Epub 2017 Aug 24.
Rifaximin might decrease the risk of portal hypertension-related complications by controlling small intestinal bacterial overgrowth.
To evaluate whether rifaximin was associated with the risk of death and cirrhotic complications.
We conducted a retrospective study that included 1042 patients experiencing hepatic encephalopathy (HE): 421 patients without hepatocellular carcinoma (HCC; the non-HCC cohort) and 621 patients with HCC (the HCC cohort). The primary endpoint was overall survival and secondary endpoints were recurrence of HE and the development of spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS) and variceal bleeding.
In the non-HCC cohort, 145 patients received rifaximin plus lactulose (the rifaximin group) and 276 patients received lactulose alone (the control group). The multivariate analysis revealed that rifaximin was significantly associated with lower risk of death (adjusted hazard ratio [aHR], 0.697; P = .024) and reduced the risk of recurrent HE (aHR, 0.452; P < .001), SBP (aHR, 0.210; P < .001) and variceal bleeding (aHR, 0.425; P = .011) but not HRS (aHR, 0.598; P = .08). In the HCC cohort, 173 patients received rifaximin plus lactulose and 448 patients received lactulose. Rifaximin was not associated with the risk of death (aHR, 1.177; P = .121). Rifaximin was associated with lower risk of SBP (aHR, 0.323; P < .001) but not with variceal bleeding (aHR, 0.660; P = .104) or recurrent HE (aHR, 0.689; P = .057). The risk of Clostridium difficile-associated diarrhoea was not different between the groups (aHR, 0.028; P = .338).
In patients without HCC, rifaximin treatment was significantly associated with prolonged overall survival and reduced risks of spontaneous bacterial peritonitis, variceal bleeding and recurrent hepatic encephalopathy.
利福昔明可能通过控制小肠细菌过度生长来降低门静脉高压相关并发症的风险。
评估利福昔明是否与死亡风险和肝硬化并发症相关。
我们进行了一项回顾性研究，纳入了1042例肝性脑病（HE）患者：421例无肝细胞癌（HCC；非HCC队列）患者和621例HCC患者（HCC队列）。主要终点是总生存期，次要终点是HE复发、自发性细菌性腹膜炎（SBP）、肝肾综合征（HRS）和静脉曲张出血的发生情况。
在非HCC队列中，145例患者接受利福昔明加乳果糖治疗（利福昔明组），276例患者仅接受乳果糖治疗（对照组）。多因素分析显示，利福昔明与较低的死亡风险显著相关（调整后风险比[aHR]，0.697；P = 0.024），并降低了HE复发风险（aHR，0.452；P < 0.001）、SBP风险（aHR，0.210；P < 0.001）和静脉曲张出血风险（aHR，0.425；P = 0.011），但未降低HRS风险（aHR，0.598；P = 0.08）。在HCC队列中，173例患者接受利福昔明加乳果糖治疗，448例患者接受乳果糖治疗。利福昔明与死亡风险无关（aHR，1.177；P = 0.121）。利福昔明与较低的SBP风险相关（aHR，0.323；P < 0.001），但与静脉曲张出血（aHR，0.660；P = 0.104）或HE复发（aHR，0.689；P = 0.057）无关。两组艰难梭菌相关性腹泻的风险无差异（aHR，0.028；P = 0.338）。
在无HCC患者中，利福昔明治疗与延长总生存期以及降低自发性细菌性腹膜炎、静脉曲张出血和肝性脑病复发风险显著相关。
