Clinical Research On High-Dose Glucocorticoid Used For Preventing Occurrence Of Liver Failure In Patients With Severe Acute Exacerbation Of Chronic Hepatitis B

BackgroundAccording to the latest statistics,there are 20 million patients with chronic hepatitis B in China,and about 1%patients with CHB may develop into liver failure due to severe acute exacerbation.The mortality rate of patients with liver failure was as high as 60%?80%.Some surviving patients taken the treatment would spend a lot of medical resources,resulting in a heavy social and economic burden.So,preventing the occurrence of liver failure in patients with severe acute exacerbation of chronic hepatitis B will have great significance.Doctors should diagnose and make a treatment plan in time according to the patients' symptoms,signs and the results of laboratory tests in clinical work,only in this way can we prevent occurrence of liver failure in patients with severe acute exacerbation of chronic hepatitis B.Now there is no effective treatment in liver failure in addition to liver transplantation.The conventional treatment including antiviral therapy,support treatment,liver protection treatment,immunological therapy,prevention and treatment of complications,artificial liver support-system and so on,had no satisfying effect in patients with liver failure.The mortality of liver failure was still high.So it's the major topic for clinicians and researchers to find out a effective,safe and economic method to prevennt occurrence of acute-on-chronic(subacute)liver failure and improve the survival rate of liver failure patients.Glucocorticoids had been used for treating liver failure with 60 years.Glucocorticoids can suppress the immune response,reduce the inflammatory medias,stable the liver cell membranes,protect the liver cells,reduce the liver cell necrosis.Glucocorticoids is a ideal drug for liver failure treatment in theory.Butdifferent research get different result by using glucocorticoids to treat liver failure patients recently,so there are widespread controversies about using glucocorticoids to treat liver failure patients.ObjectiveTo evaluate the clinical efficacy and safety of high-dose glucocorticoid in the treatment of patients with severe acute exacerbation of chronic hepatitis BTo find a safe,effective and inexpensive method to prevent occurrence of Acute-on-chronic(subacute)liver failure in patients with severe acute exacerbation of chronic hepatitis B.MethodsSlected 60 patients with severe acute exacerbation of chronic hepatitis B who were hospitalized in the infectious diseases department,the first affiliatedhospital,ZheJiang university and the severe liver diseases department of the 6th people's hospital from January 2008 to December 2011.According to whether to use steroid,these patients were divided into the steroid treatment group and the control group,each group of 30 cases.The control group received conventional treatment,the steroid group received conventional treatment plus methylprednisolone 240 mg/day for 5 days,evaluated the clinical effect on the sixth day,and then they were taken 40mg prednisolone tablets every day,then the dose of prednisolone tablets began to reduce gradually until the course of treatment reached 35 days.The changes of clinical symptoms,signs and liver function in the two groups were observed before and after therapy.The effects of preventing occurrence of liver failure on the 15th day and the survival rate on the 40th day and the 90th day were recorded.The side effects and complications of each group were monitored.Results.On the 5th day after the treatment,most of the digestive manifestations such as nausea and vomiting in the steroid group was obviously improved,but the control group didn't improved obviously.The liver function tests of all patients improved after treatment,the difference of ascensional range of PTA and falling range of ALT between two groups was statistically significant,but the difference of the changes of TB,ALB,GLB were not statistically significant.On the 5th day,the effective rate of the steroid group and the control group were 73.0%(22/30)and 20.0%(6/30),the difference was statistically significant(P<0.05).On the 15th day,The percentage of patients who didn't occur liver failure was 80.0%(24/30)in the steroid group,while it was 46.7%(14/30)in the control group,the difference was statistically significant(P<0.01).On the 40th day,The survival rates of the steroid group and the control group were 93.3%(28/30)and 90.0%(27/30),the difference was not statistically significant(P>0.05).On the 90th day,the survival rates of the steroid group and the control group were 93.3%(28/30)and 60.0%(18/30),the difiference was statistically significant(P<0.01).There was no statistical difference in the incidence of complications of between the two groups(P>0.05).Conclusion(s)The administration of short course high-dose glucocorticoid to patients with severe acute exacerbation of chronic hepatitis B had obvious effect and good security.The occurrence of liver failure can be prevented.The mortality was significantly reduced.