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首页> 外文期刊>World Journal of Gastroenterology >Importance of adequate immunosuppressive therapy for the recovery of patients with 'life-threatening' severe exacerbation of chronic hepatitis B.
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Importance of adequate immunosuppressive therapy for the recovery of patients with 'life-threatening' severe exacerbation of chronic hepatitis B.

机译：适当的免疫抑制疗法对于“威胁生命”的慢性乙肝严重加重患者的康复至关重要。

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AIM: Hepatitis B virus (HBV) re-activation often occurs spontaneously or after withdrawal of immunosuppressive therapy in patients with chronic hepatitis B. Severe exacerbation, sometimes developing into fulminant hepatic failure, is at high risk of mortality. The efficacy of corticosteroid therapy in "clinically severe" exacerbation of chronic hepatitis B has not been well demonstrated. In this study we evaluated the efficacy of early introduction of high-dose corticosteroid therapy in patients with life-threatening severe exacerbation of chronic hepatitis B. METHODS: Twenty-two patients, 14 men and 8 women, were defined as "severe" exacerbation of chronic hepatitis B using uniform criteria and enrolled in this study. Eleven patients were treated with corticosteroids at 60 mg or more daily with or without anti-viral drugs within 10 d after the diagnosis of severe disease ("early high-dose" group) and 11 patients were either treated more than 10 d or untreated with corticosteroids ("non-early high-dose" group). RESULTS: Mean age, male-to-female ratio, mean prothrombin time (PT) activity, alanine transaminase (ALT) level, total bilirubin level, positivity of HBeAg, mean IgM-HBc titer, and mean HBV DNA polymerase activity did not differ between the two groups. Ten of 11 patients of the "early high-dose" group survived, while only 2 of 11 patients of the "non-early high-dose" group survived (P<0.001). During the first 2 wk after the introduction of corticosteroids, improvements in PT activities and total bilirubin levels were observed in the "early high-dose" group. Both ALT levels and HBV DNA polymerase levels fell in both groups. CONCLUSION: The introduction of high-dose corticosteroid can reverse deterioration in patients with "clinically life-threatening" severe exacerbation of chronic hepatitis B, when used in the early stage of illness.
机译：目的：慢性乙型肝炎患者通常会自发发生乙肝病毒（HBV）重新激活或停止免疫抑制治疗后重新激活。严重加重发作，有时发展为暴发性肝衰竭，具有很高的死亡风险。尚未很好地证明皮质类固醇疗法在慢性乙型肝炎的“临床严重”加重中的功效。在这项研究中，我们评估了早期引入大剂量皮质类固醇激素治疗对威胁生命的慢性乙型肝炎的严重加重的疗效。方法：22例患者中，男14例，女8例，被定义为“严重”加重。慢性乙型肝炎采用统一标准并入选本研究。 11名患者在诊断出严重疾病后的10天内每天接受60 mg或更高剂量的糖皮质激素治疗，无论是否接受抗病毒药物治疗（“早期大剂量”组），而11例患者接受了10 d以上的治疗或未接受过抗病毒药治疗皮质类固醇（“非早期大剂量”组）。结果：平均年龄，男女比例，平均凝血酶原时间（PT）活性，丙氨酸转氨酶（ALT）水平，总胆红素水平，HBeAg阳性，平均IgM-HBc滴度和平均HBV DNA聚合酶活性无差异两组之间。 “早期高剂量”组的11例患者中有10例存活，而“非早期高剂量”组的11例患者中只有2例存活（P <0.001）。在引入皮质类固醇后的头2周内，“早期大剂量”组的PT活性和总胆红素水平有所改善。两组的ALT水平和HBV DNA聚合酶水平均下降。结论：在疾病的早期阶段使用大剂量皮质类固醇可以逆转“威胁临床生命”的慢性乙型肝炎严重加重患者的病情恶化。

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