Maddrey W C, Boitnott J K, Bedine M S, Weber F L, Mezey E, White R I
Gastroenterology. 1978 Aug;75(2):193-9.
Fifty-five patients with alcoholic hepatitis were studied in a 28- to 32-day randomized double blind treatment trial comparing prednisolone (40 mg per day) with placebo therapy. Of 31 placebo-treated patients, 4 died during the study interval and 2 more died within 5 days of study completion. Only 1 of 24 prednisolone-treated patients died during the same interval (Fisher exact test; P = 0.10). Stepwise discriminant analysis of laboratory factors associated with death revealed independently significant associations with prolongation of prothrombin time and height of serum bilirubin at the initiation of the study. When treatment was included as a variable in this discriminant analysis, it was found that corticosteroid therapy significantly decreased mortality (P less than 0.05). The corrected wedged hepatic venous presure decreased to a similar extent in the two groups. These studies suggest that corticosteroid therapy does decrease early mortality in patients with severe alcoholic hepatitis, but has no short term effect on the development of portal hypertension.
在一项为期28至32天的随机双盲治疗试验中，对55例酒精性肝炎患者进行了研究，比较泼尼松龙（每日40毫克）与安慰剂治疗。在31例接受安慰剂治疗的患者中，4例在研究期间死亡，另有2例在研究结束后5天内死亡。在24例接受泼尼松龙治疗的患者中，同一时期只有1例死亡（Fisher精确检验；P = 0.10）。对与死亡相关的实验室因素进行逐步判别分析发现，在研究开始时，凝血酶原时间延长和血清胆红素水平与死亡存在独立的显著关联。当将治疗作为该判别分析中的一个变量时，发现皮质类固醇治疗显著降低了死亡率（P小于0.05）。两组的校正肝静脉楔压下降程度相似。这些研究表明，皮质类固醇治疗确实可降低重症酒精性肝炎患者的早期死亡率，但对门静脉高压的发展没有短期影响。
