The Research To The Effect Of Glucocorticoid Therapy On The Prognosis Of Hepatic Failure

Objective: To explore the effect of glucocorticoids(GCs)on the prognosis of liver failure.Method: Retrospective analysis of clinical data of 42 patients with liver failure treated with GCs,including age,gender,clinical biochemical indicators,coagulation parameters,time interval from diagnosis of liver failure to application of GCs,and survival at 3 months,according to the short-term prognosis of patients(3 months follow-up)were divided into survival group and death group.The clinical indicators and laboratory results between the two groups were compared and analyzed.According to the baseline MELD value,MELD<25 points and MELD325 were divided into two groups.3 months mortality rate;according to the baseline PTA value,divided into PTA ?30%,PTA > 30% two groups,comparing the mortality of the two groups for 3 months;according to the way of GCs administration into continuous administration group and intermittent In the drug group,the mortality of the two groups was compared for 3 months;according to the cause,the hepatitis virus infection group and the non-hepatitis virus infection group were compared,and the three-month mortality rate of the two groups was compared.Chi-square test and t-test were used to analyze the efficacy of GCs in the treatment of liver failure and related factors affecting prognosis.Results: 1.The MELD score of 42 patients with GCs before treatment was(20.05±7.76),and the MELD score was(17.62±1.27)on the 6th day after GCs treatment.The difference was statistically significant(t=3.059,P =0.004<0.05).2.There were 30 patients in the survival group and 12 patients in the death group.The baseline MELD score of the survival group was(18.16±6.74),which was significantly lower than that of the death group(24.77±8.41)(t=2.678,P=0.011<0.05).3.Baseline PTA [48.20±18.37] in the survival group was significantly higher than that in the death group [30.08±15.42],(P=0.006<0.05).4.PTA increased 6 days after treatment with GCs in the survival group [17.30±22.89],which was significantly higher than that in the death group [3.19±8.01](P=0.025<0.05).5.MELD <25 points(n = 34),MELD 325 points(n = 8),the mortality rate of the two groups were 17.65%,75.00%,the difference was statistically significant(P = 0.001 <0.05).6.PTA?30%(n=10)and PTA>30%(n=32).The mortality rates of the two groups were 60% and18.75%,respectively,and the difference was statistically significant(P=0.012<0.05).7.Cholinesterase(CHE),blood glucose(GLU),alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB)in the surviving and death groups before treatment.There was no significant difference in the levels of bilirubin(TBIL)(P>0.05).8.There was no significant difference in the mortality of patients with hepatitis virus-infected liver failure and non-hepatitis virus-infected liver failure at 3 months(P>0.05);continuous administration group(n=24),intermittent administration The group(n=18)had a 3-month mortality rate of 29.17% and 27.78%,respectively,and the difference was not statistically significant(P=0.921>0.05).Conclusion: When MELD <25 points,PTA>30,low-dose,short-term treatment with GCs can improve liver function in patients with liver failure and improve short-term(3 months)survival rate;hepatitis virus infection is not a poor prognostic factor for GCs in the treatment of liver failure.