Giri Suprabhat, Khatana Gaurav, Gore Prasanna, Praharaj Dibya L, Kulkarni Anand V, Anand Anil C
Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India.
Department of Gastroenterology, Government Medical College, Kottayam, India.
J Clin Exp Hepatol. 2025 Sep-Oct;15(5):102557. doi: 10.1016/j.jceh.2025.102557. Epub 2025 Mar 24.
BACKGROUND/AIMS: The cholestatic hepatitis associated with acute viral hepatitis leads to prolonged jaundice and pruritus. While several treatment approaches have been proposed, there is a noticeable absence of agreement over the most effective course of action. The goal of this systematic review is to compile and assess the available data on treatment approaches for prolonged hepatitis associated with viral hepatitis.
We comprehensively searched for relevant studies in MEDLINE, Embase, and Scopus from their inception to May 2024. Studies reporting the treatment option for the management of the cholestatic phase associated with viral hepatitis were included.
A total of 28 studies describing 164 patients were included in the review, of which 18 were case reports, 8 were case series, and 2 were interventional studies. The benefit of ursodeoxycholic acid (UDCA) was reported in two case reports, with doses varying from 10 to 30 mg/kg/d in the included studies. The use of corticosteroids in adult patients was reported in 21 studies, with prednisolone doses varying from 30 to 60 mg/day in adults. Two studies used nasobiliary drain (NBD) for patients who failed to respond to conventional therapy. Lastly, three studies reported using plasma exchange (PLEX) in patients refractory to standard treatment.
Patients not responding to UDCA or cholestyramine may benefit from a short course of corticosteroids, suggesting an immune-mediated phenomenon. NBD placement or PLEX may be tried after analyzing the risk-to-benefit ratio for patients who are nonresponsive to corticosteroids. Further research is required to determine the optimal treatment strategy.
背景/目的：与急性病毒性肝炎相关的胆汁淤积性肝炎会导致黄疸和瘙痒持续时间延长。虽然已经提出了几种治疗方法，但对于最有效的治疗方案尚无明显共识。本系统评价的目的是汇总和评估有关病毒性肝炎相关迁延性肝炎治疗方法的现有数据。
我们全面检索了MEDLINE、Embase和Scopus从创刊至2024年5月的相关研究。纳入报告病毒性肝炎相关胆汁淤积期管理治疗选择的研究。
本评价共纳入28项描述164例患者的研究，其中18项为病例报告，8项为病例系列，2项为干预性研究。两项病例报告中报道了熊去氧胆酸（UDCA）的益处，纳入研究中的剂量为10至30mg/kg/天。21项研究报告了成人患者使用皮质类固醇，成人泼尼松龙剂量为30至60mg/天。两项研究对常规治疗无反应的患者使用鼻胆管引流（NBD）。最后，三项研究报告对标准治疗难治的患者使用血浆置换（PLEX）。
对UDCA或考来烯胺无反应的患者可能从短期皮质类固醇治疗中获益，提示存在免疫介导现象。对于对皮质类固醇无反应 的患者，在分析风险效益比后可尝试放置NBD或进行PLEX。需要进一步研究以确定最佳治疗策略。
