血浆置换离心技术联合小剂量类固醇治疗极重度酒精性肝炎患者：一项回顾性分析。
Centrifugal technique of plasma exchange and low-dose steroid to treat very severe alcoholic hepatitis patients: A retrospective analysis.
作者信息
Kumar Santhosh E, Chellaiya Gayathiri K, Singh Kunwar A, Karuppusami Reka, Daniel Dolly, David Vinoi G, Nair Sukesh C, Varughese Santosh, Mammen Joy, Elias Elwyn, Eapen Chundammanil E, Zachariah Uday G, Goel Ashish
机构信息
Department of Hepatology, Christian Medical College, Vellore, 632 004, India.
Department of Transfusion Medicine and Immunohematology, Christian Medical College, Vellore, 632 004, India.
出版信息
Indian J Gastroenterol. 2025 Jun;44(3):345-354. doi: 10.1007/s12664-024-01569-3. Epub 2024 Jun 7.
BACKGROUND
Low-volume plasma exchange (PLEX) and low-dose steroid improve survival in severe alcoholic hepatitis. We aimed to compare one-year survival of very severe alcoholic hepatitis (VSAH) patients treated with centrifugal PLEX (cPLEX), membrane PLEX (mPLEX) or standard medical treatment (SMT).
METHODS
We retrospectively analyzed survival in consecutive VSAH patients treated at our department from November 2017 to September 2021. PLEX patients received low-volume PLEX along with low-dose steroid (tab. prednisolone 10 mg or 20 mg daily). To adjust for baseline differences between the three treatment (cPLEX, mPLEX or SMT) groups, propensity score (PS) matching was done. Acute-on-chronic liver failure (ACLF) was defined as per European Association for the Study of the Liver (EASL). The primary study outcome was one-year transplant-free survival of PS-matched VSAH patients treated with cPLEX compared to SMT.
RESULTS
Of 101 PLEX-eligible VSAH patients, 30 patients were treated with cPLEX, 21 with mPLEX and 50 with SMT. On comparing 30 PS-matched patients each in the cPLEX group vs. the SMT group, transplant-free survival in the cPLEX group was 86.7% at one month, 70% at three months and 52.4% at one year and in the SMT group was 33.3% at one month, 23.3% at three months and 16.7% at one year with hazard ratio (HR [95% CI]) in favor of the cPLEX group (0.29 [0.15-0.56], p < 0.001). Total 21 patients each (PS-matched) in cPLEX and mPLEX groups were compared and one-year survival was better with cPLEX (0.33 [0.16-0.69], p = 0.001). The sub-group analysis of VSAH (PS-matched cohort) patients with ACLF also showed better survival with cPLEX compared to SMT (0.38 [0.17-0.83], p = 0.003) and compared to mPLEX (0.43 [0.17-0.95], p = 0.03).
CONCLUSION
Better one-year transplant-free survival was noted among PS-matched VSAH patients treated with cPLEX (and low-dose steroid) compared to SMT (without steroid).
背景
小容量血浆置换（PLEX）和低剂量类固醇可提高重症酒精性肝炎患者的生存率。我们旨在比较接受离心式PLEX（cPLEX）、膜式PLEX（mPLEX）或标准药物治疗（SMT）的极重度酒精性肝炎（VSAH）患者的一年生存率。
方法
我们回顾性分析了2017年11月至2021年9月在我科接受治疗的连续性VSAH患者的生存情况。接受PLEX治疗的患者接受小容量PLEX并联合低剂量类固醇（泼尼松龙片每日10毫克或20毫克）。为了调整三组治疗（cPLEX、mPLEX或SMT）之间的基线差异，进行了倾向评分（PS）匹配。根据欧洲肝脏研究协会（EASL）的定义确定慢加急性肝衰竭（ACLF）。主要研究结局是PS匹配的接受cPLEX治疗的VSAH患者与接受SMT治疗的患者的一年无移植生存率。
结果
在101例符合PLEX治疗条件的VSAH患者中，30例接受cPLEX治疗，21例接受mPLEX治疗，50例接受SMT治疗。比较cPLEX组和SMT组各30例PS匹配患者，cPLEX组1个月时的无移植生存率为86.7%，3个月时为70%，1年时为52.4%；SMT组1个月时为33.3%，3个月时为23.3%，1年时为16.7%，风险比（HR[95%CI]）有利于cPLEX组（0.29[0.15 - 0.56]，p<0.001）。比较cPLEX组和mPLEX组各21例（PS匹配）患者，cPLEX组的一年生存率更高（0.33[0.16 - 0.69]，p = 0.001）。对ACLF的VSAH（PS匹配队列）患者的亚组分析也显示，与SMT相比，cPLEX组的生存率更高（0.38[0.17 - 0.83]，p = 0.003），与mPLEX相比也是如此（0.43[0.17 - 0.95]，p = 0.03）。
结论
与接受SMT（未使用类固醇）的患者相比，接受cPLEX（和低剂量类固醇）治疗的PS匹配的VSAH患者的一年无移植生存率更高。
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