Mathurin P, Duchatelle V, Ramond M J, Degott C, Bedossa P, Erlinger S, Benhamou J P, Chaput J C, Rueff B, Poynard T
Service des Traitements Ambulatoires des Maladies Alcooliques, Hôpital Beaujon, Clichy, France.
Gastroenterology. 1996 Jun;110(6):1847-53. doi: 10.1053/gast.1996.v110.pm8964410.
BACKGROUND & AIMS: Corticosteroids have been shown to significantly decrease short-term mortality in patients with severe alcoholic hepatitis. However, independent factors associated with a favorable outcome and long-term survival are unknown. The aim of this study was to examine prognostic factors and long-term survival in patients with biopsy-proven severe alcoholic hepatitis.
Of 183 patients studied, 61 had been randomized in a previous trial; 32 of them were treated with prednisolone (group I) and 29 were not treated (group II); 61 were treated from the end of this randomized trial (group III); and 61 were simulated (group IV).
At 1 year, survival in group I (69%; confidence interval [CI], 57%-81%) and group III (71%; CI, 55%-87%) was better than in the nontreated groups (group II, 41%; CI, 23%-59%; P = 0.01) (group IV, 50%; CI, 37%-63%; P = 0.05). At 2 years, survival was not significantly different. Treated patients with marked liver polymorphonuclear infiltrate had better 1-year survival (76%; CI, 64%-88%) than the others (53%; CI, 35%-71%; P = 0.05). Treated patients with polymorphonuclear counts of > 5500/mm3 had better 1-year survival (77%; CI, 65%-89%) than the others (40%; CI, 14%-66%; P = 0.003). In the 93 treated patients, liver polymorphonuclear infiltrate (P < 0.03) and polymorphonuclear count (P < 0.001) were independently correlated with 1-year survival.
Prednisolone reduced mortality by at least 1 year. Liver polymorphonuclear infiltrate and polymorphonuclear count were independent prognostic factors.
已证实皮质类固醇可显著降低重症酒精性肝炎患者的短期死亡率。然而，与良好预后及长期生存相关的独立因素尚不清楚。本研究旨在探讨经活检证实的重症酒精性肝炎患者的预后因素及长期生存情况。
在研究的183例患者中，61例曾参与前期试验并被随机分组；其中32例接受泼尼松龙治疗（I组），29例未接受治疗（II组）；61例自该随机试验结束后开始接受治疗（III组）；61例为模拟组（IV组）。
1年时，I组（69%；置信区间[CI]，57% - 81%）和III组（71%；CI，55% - 87%）的生存率高于未治疗组（II组，41%；CI，23% - 59%；P = 0.01）（IV组，50%；CI，37% - 63%；P = 0.05）。2年时，生存率无显著差异。有明显肝脏多形核白细胞浸润的治疗患者1年生存率（76%；CI，64% - 88%）高于其他患者（53%；CI，35% - 71%；P = 0.05）。多形核白细胞计数>5500/mm³的治疗患者1年生存率（77%；CI，65% - 89%）高于其他患者（40%；CI，14% - 66%；P = 0.003）。在93例接受治疗的患者中，肝脏多形核白细胞浸润（P < 0.03）和多形核白细胞计数（P < 0.001）与1年生存率独立相关。
泼尼松龙可降低至少1年的死亡率。肝脏多形核白细胞浸润和多形核白细胞计数是独立的预后因素。
