Timing of glucocorticoid therapy for liver failure
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摘要: 糖皮质激素治疗肝衰竭一直存在争议,现有的肝衰竭相关指南中也对激素的应用谨慎推荐。但是从最新的研究可见,肝衰竭早期或者前期应用激素治疗可能患者受益更多。年龄、病情进展速度和严重程度、肝衰竭相关并发症的发生均会影响治疗效果,如何选择合适的患者、药物和剂量、时机仍需要继续研究探讨。Abstract: There are still controversies over the use of glucocorticoids in the treatment of liver failure, and current guidelines for liver failure recommend that glucocorticoids should be used with great caution. However, some latest studies have shown that the use of glucocorticoid therapy in the early stage of liver failure can bring more benefits to patients. Age, disease progression rate and severity, and complications of liver failure may affect the treatment outcome. Further studies are still needed for the selection of right patients, drugs and dose, and treatment timing.
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Key words:
- liver failure /
- glucocorticoids /
- therapy
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[1]Chinese Society of Hepatology, Chinese Medical Association;Chinese Society of Gastroenterology, Chinese Medical Association;Chinese Society of Infectious Diseases, Chinese Medical Association.Consensus on the diagnosis and management of autoimmune hepatitis (2015) [J].J Clin Hepatol, 2016, 32 (1) :9-22. (in Chinese) 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会感染病学分会.自身免疫性肝炎诊断和治疗共识 (2015) [J].临床肝胆病杂志, 2016, 32 (1) :9-22. [2] European Association for the Study of the Liver.EASL clinical practice guidelines:autoimmune hepatitis[J].J Hepatol, 2015, 63 (4) :971-1004. [3]Fatty Liver and Alcoholic Liver Disease Study Group of the Chinese Liver Disease Association, Chinese Medical Association.Guidelines for prevention and treatment of alcoholic liver disease (revised version 2010) [J].J Clin Hepatol, 2010, 26 (3) :229-232. (in Chinese) 中华医学会肝病学分会脂肪肝和酒精性肝病学组.酒精性肝病诊疗指南 (2010年修订版) [J].临床肝胆病杂志, 2010, 26 (3) :229-232. [4]European Association for the Study of Liver.EASL clinical practical guidelines:management of alcoholic liver disease[J].J Hepatol, 2012, 57 (2) :399-420. [5]O'SHEA RS, DASARATHY S, MCCULLOUGH AJ, et al.Alcoholic liver disease[J].Hepatology, 2010, 51 (1) :307-328 [6] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association;Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association.Guidelines for diagnosis and treatment liver failure[J].Chin J Clin Infect Dis, 2012, 5 (6) :321-327. (in Chinese) 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南 (2012年版) [J].中华临床感染病杂志, 2012, 5 (6) :321-327. (in Chinese) [7]KARKHANIS J, VERNA EC, CHANG MS, et al.Steroid use in acute liver failure[J].Hepatology, 2014, 59 (2) :612-621. [8]ZHAO B, ZHANG HY, XIE GJ, et al.Evaluation of the effcacy of steroid therapy on acute liver failure[J].Exp Ther Med, 2016, 12 (5) :3121-3129. [9]THURSZ MR, RICHARDSON P, ALLISON M, et al.Prednisolone or pentoxifylline for alcoholic hepatitis[J].N Engl J Med, 2015, 372 (17) :1619-1628. [10]LEE YS, KIM HJ, KIM JH, et al.Treatment of severe alcoholic hepatitis with corticosteroid, pentoxifylline, or dual therapy:a systematic review and meta-analysis[J].J Clin Gastroenterol, 2017, 51 (4) :364-377. [11]MATHURIN P, LOUVET A, DUHAMEL A, et al.Prednisolone with vs without pentoxifylline and survival of patients with severe alcoholic hepatitis:a randomized clinical trial[J].JAMA, 2013, 310 (10) :1033-1041. [12]NGUYEN-KHAC E, THEVENOT T, PIQUET MA, et al.Glucocorticoids plus N-acetylcysteine in severe alcoholic hepatitis[J].N Engl J Med, 2011, 365 (19) :1781-1789. [13]YEOMAN AD, WESTBROOK RH, ZEN Y, et al.Prognosis of acute severe autoimmune hepatitis (AS-AIH) :the role of corticosteroids in modifying outcome[J].J Hepatol, 2014, 61 (4) :876-882. [14]MENDIZABAL M, MARCIANO S, VIDELA MG, et al.Fulminant presentation of autoimmune hepatitis:clinical features and early predictors of corticosteroid treatment failure[J].Eur J Gastroenterol Hepatol, 2015, 27 (6) :644-648. [15]ZHU B, YOU SL, WAN ZH, et al.Clinical characteristics and corticosteroid therapy in patients with autoimmune-hepatitis-induced liver failure[J].World J Gastroenterol, 2014, 20 (23) :7473-7379. [16]YANG XK, XU GS.Efficacy of glucocorticoid in treatment of HBV-related hepatic failure:a meta-analysis[J].Med J Chin PLA, 2013, 38 (7) :581-585. (in Chinese) 杨晓鲲, 徐贵森.糖皮质激素治疗乙型肝炎病毒相关性肝衰竭疗效的Meta分析[J].解放军医学杂志, 2013, 38 (7) :581-585. [17]HE B, ZHANG Y, LV MH, et al.Glucocorticoids can increase the survival rate of patients with severe viral hepatitis B:a meta-analysis[J].Eur J Gastroenterol Hepatol, 2013, 25 (8) :926-934. [18]CHEN JF, WANG KW, ZHANG SQ, et al.Dexamethasone in outcome of patients with hepatitis B virus-related acute-on-chronic liver failure[J].J Gastroenterol Hepatol, 2014, 29 (4) :800-806. [19]LI J, WANG LW, GONG ZJ.Efficacy and safety of glucocorticoids on patients with severe viral hepatitis:a meta-analysis[J].J Pract Hepatol, 2011, 14 (2) :121-124. (in Chinese) 李晶, 王鲁文, 龚作炯.糖皮质激素治疗重型肝炎有效性及安全性的Meta分析[J].实用肝脏病杂志, 2011, 14 (2) :121-124. [20]LI J, WU J, LIU HX, et al.Early bilirubin response in acute-on-chronic hepatitis B liver failure patients treated with corticosteroids predicates a lower 3-month mortality[J].Int J Clin Exp Med, 2016, 9 (6) :10364-10373. [21]ZHANG XQ, JIANG L, YOU JP, et al.Efficacy of short-term dexamethasone therapy in acute-on-chronic pre-liver failure[J].Hepatol Res, 2011, 41 (1) :46-53. [22]ZHANG GL, GAO ZL.The immunological characteristics of and treatment strategies for HBV related acute on chronic liver failure[J].Chin J Viral Dis, 2011, 1 (1) :5-8. (in Chinese) 张耿林, 高志良.乙型肝炎相关慢加急性肝衰竭的免疫学特征及治疗策略[J].中国病毒病杂志, 2011, 1 (1) :5-8. [23]AMBROSINO G, NASO A, FELTRACCO P, et al.Cytokines and liver failure:modification of TNF-αand IL-6 in patients with acute on chronic liver decompensation treated withmolecular adsorbent recycling system (MARS) [J].Acta Biome, 2003, 74 (Suppl2) :7-9. [24]JALAN R, GINES P, OLSON JC, et al.Acute-on chronic liver failure[J].J Hepatol, 2012, 57 (6) :1336-1348. [25]ZHANG XQ, NIE QH.Eleventh, the application and evaluation of glucocorticoid in the treatment of severe hepatitis[J].J Pract Hepatol, 2004, 7 (2) :70-72. (in Chinese) 张绪清, 聂青和.第十一讲糖皮质激素在治疗重型肝炎中的应用及评价[J].实用肝脏病杂志, 2004, 7 (2) :70-72. [26]ZHU YK, JIA L, LI J, et al.Effect of methylprednisolone on peripheral blood dendritic cells in patients with exacerbation of chronic hepatitis B and clinical significance[J].Chin J Clin Infect Dis, 2016, 9 (5) :433-438. (in Chinese) 朱跃科, 贾琳, 李娟, 等.甲泼尼龙治疗对慢性乙型肝炎重症化趋势患者外周血树突细胞的影响与临床意义[J].中华临床感染病杂志, 2016, 9 (5) :433-438. [27]HU PF, WANG PQ, CHEN H, et al.Beneficial effect of corticosteroids for patients with severe drug-induced liver injury[J].JDig Dis, 2016, 17 (9) :618-627. [28]KOTOHL K, ENJOJIL M, Nakamuta I M, et al.Arterial steroid injection therapy can inhibit the progression of severe acute hepatic failure toward fu Iminanti liver failure[J].World J Gastroenterol, 2006, 12 (41) :6678-6682. [29]FUJIWARA K, YASUI S, YONEMITSU Y, et al.Efficacy of high-dose corticosteroid in the early stage of viral acute liver failure[J].Hepatol Res, 2014, 44 (5) :491-501. [30]YASUI S, FUJIWARA K, HAGA Y, et al.Infectious complications, steroid use and timing for emergency liver transplantation in acute liver failure:analysis in a Japanese center[J].J Hepatobiliary Pancreat Sci, 2016, 23 (12) :756-762.
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