Study On The Efficacy And Safety Of Glucocorticoids In The Treatment Of HBV-related Liver Failure

Objective:To observe the effect of glucocorticoids treatment in patients with the prophase and early stage of liver failure which induced only by HBV,Moreover,to investigate its safety on those patitents during the process of treatment,provide a reference for clinical treatment.Methods:128 patients with prophase and early stage of HBV-related liver failure who met the criteria were divided into glucocorticoid treatment group and the routine group according to with/without glucocorticoid treatment.The routine group was given the conventional medical therapy which included antiviral treatment with entecavir or lamivudine combined with adefovir,protecting liver,suppling plasma and albumin,preventing infection.while in the glucocorticoid group,short-term treatment combined with methylprednisolone on the basis of conventional medical therapy,the drug regimen for glucocorticoids:continuous intravenous drip treatment applications with methylprednisolone,40-80mg per day,withdrawn and reduced after 3-7days,the total course of treatment is not more than 2weeks.The observation ended at 12 weeks,then the results of the two groups were compared including the weekily level of ALT,TBil,PTA,ALB in the first four weeks,the effective rate and the side effect incidence rate and the level variation of HBV-DNA at 4 weeks,the the mortality rate at 12 weeks.Results:(1)The basic situation of the two groups compared:Keep the concordance in the course and there was no statistically significant difference of age,sex,and the level of ALT,TBil,PTA,ALB before the start of the treatment between the two groups(P>0.05).(2)The level variation of ALT,TBil,PTA,ALB in the two group:(1)ALT:The serum ALT level of the two groups decreased gradually with the duration of treatment,moreover,there was no statistically significant difference between the two groups at different time points(P>0.05).(2)TBil:The serum TBil concentration decreased continuously during a session in both groups and the glucocorticoid treatment group was lower all the time,it had statistically difference except at 2 weeks(P<0.05),moreover the diffrence holds a tendency of increase except decrease in the second week.(3)PTA:The serum PTA level rised gradually and the glucocorticoid treatment groups was higher at different time points(P<0.05),the difference between the two groups increased gradually with time-lapse.(4)ALB:The serum ALB level of glucocorticoid treatment group rise gradually and the routine group showed a gradual increase after decrease in the first week of treatment.At different time points,the glucocorticoid treatment group was consistently higher(P<0.05)and the difference between the two groups enlarged with the treatment prolonged.(3)The efficiency comparison between the two groups in 4 weeks:The treatment was effective in 23 patients,among them,15 were improved and 8 relieved in glucocorticoid treatment group;The therapy for 57 patients of routine group was effective including improved in 15 and relieved in 18.The effective rate in glucocorticoid treatment group was 85.19%(23/27)higher than that of the routine group 56.44%(57/101),it had statistical difference(P<0.05).(4)The mortality rate comparison between the two groups at 12 weeks of follow-up:1patient in the glucocorticoid treatment group lost a visit and 7 patients that in the routine group.The results of the two groups are compared after elimination of lost cases:3.85%(1/26)of patients have died in glucocorticoid treatment group lower than 31.91%(30/94)in routine group with statistical difference(P<0.05).(5)The comparison of side effects rates in 4 weeks:(1)The infection rates of patients in glucocorticoid treatment group was18.52%(5/27)lower than the routine group 39.60%(40/101),it had no statistical difference(P<0.05).(2)There was no(0/27)patients with gastrointestinal hemorrhage in treatment group,which was not significantly different from 5.94%(6/101)of that in routine group(P>0.05).(3)Compared with the occurent rate of hepatic encephalopathy 7.41%(2/27)in glucocorticoid treatment group,there was no statistical difference in the routine group 8.91%(9/101)(P>0.05).(4)There was no statistical difference of occurent rate of hepatorenal syndrome between glucocorticoid treatment group 0.00%(0/27)and routine group 6.93%(7/101)(P>0.05).(5)The total complication rates of patients in glucocorticoid treatment group was 25.93%(7/27)lower than the routine group 61.39%(62/101)with statistical difference(P<0.05).(6)The level variation of HBV-DNA in 4 weeks(comment:HBV-DNA negative means the level of HBV-DNA lower than limit of detection(LOD)and LOD of HBV-DNA is 5×10~2Copies/ML in our hospital):(1)The comparison of the HBV-DNA negative conversion rates in the two groups:HBV-DNA negative rate in the glucocorticoid treatment group was 74.07%(20/27)higher than that of the routine group66.34%(67/101),there was no statistically significant differences between the two groups(P>0.05).(2)HBV-DNA could not be detected in two groups(log10 Copies/ML):The level of HBV-DNA in the glucocorticoid treatment group was 6.18±1.42 and that of routine group was 6.34±1.52 before treatment,the glucocorticoid treatment group was 3.76±0.49 and the routine group was 3.77±0.87 in 4 weeks.After therapy,the level of HBV-DNA was lower than the before in both groups,and there was no significant statistical differences of HBV-DNA level before and after therapy between the two groups(P>0.05).Conclusion:The patients with prophase and early stage of HBV-related liver failure which were given short-term treatment of Methylprednisolone combined with the convational treatment including powerful antiviral therapy with nucleoside analogues,protecting liver,supportive therapy,that can block the progress of their disease,improve liver function rapidly,raise curative effect and the prognosis can be improved accordingly.During the treatment,neither the risk of complications increased such as infection and gastrointestinal bleeding,nor does it activate the hepatitis B virus,furthermore,the disease didn?t reoccured in a sudden withdrawal or reduced quickly of glucocorticoid.