Glavind Emilie, Aagaard Niels Kristian, Gronbaek Henning, Orntoft Nikolaj Worm, Vilstrup Hendrik, Thomsen Karen Louise
a Department of Hepatology and Gastroenterology , Aarhus University Hospital , Aarhus , Denmark.
Scand J Gastroenterol. 2018 May;53(5):592-597. doi: 10.1080/00365521.2017.1399163. Epub 2017 Nov 7.
Alcoholic hepatitis (AH) markedly decreases the urea synthesis capacity. We aimed to investigate the time course of this compromised essential liver function in patients with AH and its relation to treatment and survival.
Thirty patients with AH were included in a prospective cohort study. We measured the substrate-independent urea synthesis capacity, i.e., the functional hepatic nitrogen clearance (FHNC), in the patients at study entry and again at three months (survivors/available: n = 17). Patients with severe disease (Glasgow Alcoholic Hepatitis Score ≥9, n = 17) were randomized to receive either prednisolone or pentoxifylline and were in addition examined after 14 days (n = 9).
FHNC (normal range = 25-45 L/h) was markedly decreased at study entry (median = 5.6 (IQR = 3.0-9.6) L/h) and increased by three-fold in survivors at three months (15.1 (12.0-22.9) L/h; p < .001). In patients with severe AH, FHNC was also increased after 14 days of pharmacologic treatment and showed the greatest increase in the patients taking prednisolone (prednisolone 25.4 (20.6-26.2) L/h vs. pentoxifylline 12.3 (8.0-15.3) L/h; p = .05). FHNC at study entry was lower in 90-day non-survivors than in survivors (p = .04).
The decrease in the urea synthesis capacity in patients with AH was the most marked in short-term non-survivors and partly recovered in survivors at three months. In patients on pharmacologic treatment, recovery was observed already after 14 days, and it was nearly complete in those on prednisolone. Thus, metabolic liver failure in AH seems to be prognostically important, is potentially reversible, and may recover more rapidly following treatment with prednisolone.
酒精性肝炎（AH）显著降低尿素合成能力。我们旨在研究AH患者这种受损的重要肝功能的时间进程及其与治疗和生存的关系。
30例AH患者纳入一项前瞻性队列研究。我们在研究开始时以及三个月后（幸存者/可获得数据者：n = 17）测量了患者的非底物依赖性尿素合成能力，即功能性肝氮清除率（FHNC）。重度疾病患者（格拉斯哥酒精性肝炎评分≥9，n = 17）被随机分配接受泼尼松龙或己酮可可碱治疗，并在14天后再次接受检查（n = 9）。
研究开始时FHNC（正常范围 = 25 - 45 L/h）显著降低（中位数 = 5.6（四分位间距 = 3.0 - 9.6）L/h），三个月后幸存者的FHNC增加了两倍（15.1（12.0 - 22.9）L/h；p <.001）。在重度AH患者中，药物治疗14天后FHNC也有所增加，服用泼尼松龙的患者增加幅度最大（泼尼松龙25.4（20.6 - 26.2）L/h vs. 己酮可可碱12.3（8.0 - 15.3）L/h；p = 0.05）。研究开始时，90天内非幸存者的FHNC低于幸存者（p = 0.04）。
AH患者的尿素合成能力下降在短期非幸存者中最为明显，三个月后幸存者部分恢复。在接受药物治疗的患者中，14天后就观察到了恢复，服用泼尼松龙的患者恢复几乎完全。因此，AH中的代谢性肝衰竭似乎在预后方面很重要，可能是可逆的，并且在泼尼松龙治疗后恢复可能更快。
