Institute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, 21202, USA.
Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Dig Dis Sci. 2020 Dec;65(12):3726-3733. doi: 10.1007/s10620-020-06142-4. Epub 2020 Feb 18.
In this study, we assessed whether there were any survival advantages with a combination treatment of intravenous N-acetylcysteine (NAC) and prednisone over prednisone alone in those with severe alcoholic hepatitis [discriminant function (DF) ≥ 32].
Between January 1, 2013, and February 28, 2019, we identified 68 patients (mean age 47.2 years ± 10.1, 57% women, 65% cirrhosis, MELD score 28.1 ± 6.6) with alcoholic hepatitis, and of those, 21 (31%) received prednisone and 47 (69%) received prednisone + NAC. Lille score ≥ 0.45 was considered a poor response. Renal insufficiency was defined as GFR < 60 ml/min/1.73m calculated on two separate occasions.
DF (74.2 ± 33.6 vs. 56.9 ± 15.9, p = 0.09) was similar, but MELD (29.2 ± 6.3 vs. 25.5 ± 6.4, p = 0.03) scores were higher in the combination group. The overall 30-day and 90-day mortality was 13.2% (9/68) and 20.6% (14/68), respectively. Women were more likely (OR 4.86, 95% CI 1.62-14.59) to respond to treatment based on Lille score compared to men, but the type of treatment regimen had no effect on Lille score (OR 0.84, 95% CI 0.25-2.78). Treatment regimen had no effect on both adjusted and unadjusted survivals. Multivariate analysis, after adjusting for confounding variables, confirmed these observations. DF + renal insufficiency had the highest AUROC (0.86) to predict mortality.
The combination treatment of NAC + prednisone is not better than prednisone alone in patients with severe alcoholic hepatitis.
在这项研究中，我们评估了在伴有严重酒精性肝炎（判别函数 [DF]≥32）的患者中，与单独使用泼尼松相比，静脉注射 N-乙酰半胱氨酸（NAC）和泼尼松联合治疗是否具有生存优势。
在 2013 年 1 月 1 日至 2019 年 2 月 28 日期间，我们确定了 68 例酒精性肝炎患者（平均年龄 47.2±10.1 岁，57%为女性，65%为肝硬化，MELD 评分 28.1±6.6），其中 21 例（31%）接受泼尼松治疗，47 例（69%）接受泼尼松+NAC 治疗。Lille 评分≥0.45 被认为是不良反应。肾功能不全定义为两次独立检测时肾小球滤过率[GFR]＜60ml/min/1.73m。
DF（74.2±33.6 与 56.9±15.9，p=0.09）相似，但联合组的 MELD（29.2±6.3 与 25.5±6.4，p=0.03）评分更高。总的 30 天和 90 天死亡率分别为 13.2%（9/68）和 20.6%（14/68）。与男性相比，女性根据 Lille 评分对治疗的反应更可能（OR 4.86，95%CI 1.62-14.59），但治疗方案类型对 Lille 评分无影响（OR 0.84，95%CI 0.25-2.78）。治疗方案对调整后和未调整后的存活率均无影响。多变量分析，在调整混杂变量后，证实了这些观察结果。DF+肾功能不全对预测死亡率的 AUROC（0.86）最高。
在伴有严重酒精性肝炎的患者中，NAC+泼尼松联合治疗并不优于单独使用泼尼松。
