失代偿期肝硬化患者肝性脑病的一级预防：低剂量与全剂量利福昔明对比
Primary prophylaxis of hepatic encephalopathy in decompensated cirrhosis: Low dose vs. full dose rifaximin.
作者信息
Sarwar Shahid, Muhyuddin Bushra, Aleem Abdul, Nadeem Muhammad Arif
机构信息
Shahid Sarwar, MBBS, FCPS (Medicine) FCPS (Gastroenterology), MCPS-HPE, FRCP (Edin). Associate Professor of Medicine, Services Institute of Medical Sciences (SIMS), Lahore, Pakistan.
Bushra Muhyuddin, MBBS, FCPS (Medicine). Senior Registrar, Services Hospital, Lahore, Pakistan. Services Institute of Medical Sciences (SIMS), Lahore, Pakistan.
出版信息
Pak J Med Sci. 2019 Sep-Oct;35(5):1446-1450. doi: 10.12669/pjms.35.5.549.
OBJECTIVE
To compare efficacy of high vs low dose rifaximin for primary prophylaxis of portosystemic encephalopathy (PSE) in decompensated liver cirrhosis.
METHODS
In a quasi-experimental double blind randomized study at Services Institute of Medical Sciences (SIMS), Lahore from August 2017 to August 2018, patients of decompensated cirrhosis with no previous PSE were randomized to receive twice daily rifaximin 200mg in Group-A and 550mg in Group-B. Patients were followed for 6 months for development of PSE.
RESULTS
In 75 included patients, mean age was 53.8(±10.7) years and male/female ratio was 0.97/1(37/38). After randomization, 34 (45.3%) patients were included in Group-A and 41 (54.7%) patients in Group-B. During 6 month follow up 24 (32%) patients developed PSE, 12 (35.2%) in Group-A and 12 (29.2%) in Group-B, difference was not significant (p value 0.57). In 6 months, 13 (17.3%) patient died, 6 (17.6%) in Group-A and 7 (17.07%) patients in Group-B, difference not significant (p value 0.94). Patients who died had higher bilirubin (p < 0.00), higher serum creatinine (p 0.05), high CTP score (p 0.04) and worse MELD score (p 0.004).
CONCLUSION
Rifaximin is not effective for primary prophylaxis of overt hepatic encephalopathy in decompensated cirrhosis patients.
目的
比较高剂量与低剂量利福昔明对失代偿期肝硬化患者门静脉-体循环性脑病（PSE）一级预防的疗效。
方法
在拉合尔医学科学服务研究所（SIMS）于2017年8月至2018年8月进行的一项半实验性双盲随机研究中，将既往无PSE的失代偿期肝硬化患者随机分为两组，A组患者每日两次服用200mg利福昔明，B组患者每日两次服用550mg利福昔明。对患者进行6个月的随访，观察PSE的发生情况。
结果
纳入的75例患者中，平均年龄为53.8（±10.7）岁，男女比例为0.97/1（37/38）。随机分组后，A组纳入34例（45.3%）患者，B组纳入41例（54.7%）患者。在6个月的随访期间，24例（32%）患者发生PSE，A组12例（35.2%），B组12例（29.2%），差异无统计学意义（p值0.57）。6个月内，13例（17.3%）患者死亡，A组6例（17.6%），B组7例（17.07%），差异无统计学意义（p值0.94）。死亡患者的胆红素水平较高（p<0.00）、血清肌酐水平较高（p 0.05）、CTP评分较高（p 0.04）且MELD评分较差（p 0.004）。
结论
利福昔明对失代偿期肝硬化患者显性肝性脑病的一级预防无效。
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