Intervention Effect Of Glucocorticoids On Patients With HBV-related Acute-On-Chronic Pre-Liver Failure And Analysis Of Early Warning Signal Of Liver Failure

ObjectiveTo investigate the clinical efficacy and safety of short-term low-dose glucocorticoids in patients with hepatitis B virus-related acute-on-chronic pre-liver failure;To explore90-day prognostic factors in patients with HBV-related acute-on-chronic liver failure,to provide reference for clinical judgment of the disease and early intervention treatment.Methods1.According to the inclusion and exclusion criteria,the patients who meets the diagnostic criteria for hepatitis B virus-related acute-on-chronic pre-liver failurewere randomly divided into two groups:medical comprehensive treatment group(MCT group)and glucocorticoids treatmentgroup(CT group).MCT groups were treated with routine therapy,including:first-line nucleoside analogs antiviral therapy,protecting liver and lowering enzymes and improving cholestasis(Polyene phosphatidylcholine,glycyrrhizic acid preparation,adenosine methionine,etc.),artificial liver support therapy,anti-infection therapy,diuretic combined with albumin for patients with ascites,treatment of hepatic encephalopathy(HE)withornithine aspartate;CT group was added glucocorticoids the basis of routine treatment,dexamethasone 5mg/d,intravenous injection,for 5 days.Baseline demographic data,clinical indexes(including WBC,NEUT%,PLT,ALT,AST,TBIL,DBIL,TBA,ALB,GLO,BUN,SC,UA,K+,Na+,PTA)at admission and one week after admission were collected and statistically analyzed;To compare the clinical efficacy of the two groups after one week of treatment,and to count the hospitalization time and observe the adverse reactions and disease outcome during hospitalization.2.Using a retrospective study,patients who developed liver failure in the previous study continued clinical observation and expanded the sample size to 100 cases,The patientswere divided into survival group(S group)and non-survival group(NS group)according to the survival condition of the patients 90 days after the onset of the disease.The baseline demographic data,clinical indicators at admission and 1 week after admission were collected,including WBC,NEUT%,PLT,ALT,AST,TBIL,DBIL,TBA,ALB,GLO,BUN,SC,UA,K+,Na+,PTA,then Statistical analysis,To explore early warning factors in patients with liver failure.Results1.Infection is the most common cause of hepatitis B virus-related acute-on-chronic pre-liver failure,accounting for 40-60%,followed by HBV reactivation,hepatotoxic drugs,alcohol,autoimmune liver disease and chemotherapy.2.One week after glucocorticoids treatment,ALT and AST decreased significantly between the two groups,and the decrease in the CT group was more significant than that in the MCT group,[ALT:295.10(125.10,849.99)vs 73.20(54.70,138.33),Z=-5.006,P<0.001;AST:176.23(111.22,455.15)vs89.32(36.83,121.15),Z=-5.128,P<0.001];There were significant differences in the levels of TBIL,DBIL,TBA and GLO between the two groups after 1 week of admission(Z=-4.067,P<0.001;Z=-4.868,P<0.001;Z=-4.487,P<0.001;t=3.263,P<0.001).3.The hospitalization time of MCT group was longer than that of CT group(36.82±16.73vs28.38±11.38,p=0.002);There were no side effects between the two groups,such as hypertension,gastrointestinal bleeding,peptic ulcer,bacterial infection and fungal infection.4.There were 9 cases in MCT group and 5 cases in CT group of patients with HBVpre-ACLF developed HBV-ACLF,there was no statistical difference between the two groups(14.75%vs8.33%,p=0.271).5.The number of patients with ascites and hepatic encephalopathy in the NS group was more than that in the S group(43.75%vs 14.71%,37.50%vs 2.94%),and the difference was statistically significant,P<0.05);The levels of WBC,NEUT%,ALT,AST,ALB,BUN,SC and PTA in the NS group were significantly higher than those in the S group at admission,and the differences were statistically significant(t=-2.049,P=0.046;t=-4.486,P<0.001;Z=-3.665,P<0.001;Z=-2.742,P=0.006;t=3.527,P=0.001;Z=-3.50-7,P<0.001;Z=-2.598,P=0.009;t=7.086,P<0.001).6.One week after admission,the levels of WBC,NEUT%,PLT,AST,TBIL,DBIL,TBA,ALB,BUN,Na+and PTA in the NS group were significantly higher than those in the S group,and the differenceswere statistically significant(t=-2.681,P=0.010;t=-4.690,P<0.001;t=2.458,P=0.016;Z=-3.086,P<0.001;Z=-5.941,P<0.001;Z=-5.476,P<0.001;Z=-2.786,P=0.005;t=4.528,P<0.001;Z=-3.544,P<0.001;t=3.109,P=0.002;t=5.030,P<0.001).Conclusion1.Glucocorticoids can effectively inhibit the destruction of hepatocytes and improve the early liver biochemical indicators in the HBV pre-ACLF stage,shorten the hospitalization time of HBV pre-ACLF patients,but can not prevent the progress of HBV pre-ACLF diseases.2.High safety of short-term low-doseglucocorticoids therapy HBV pre-ACLF.3.The mortality rate was higher in patients with hepatic encephalopathy,ascites or renal insufficiency at admission.4.At admission and 1 week after admission,the mortality was higher in patients with high leukocyte/neutrophil ratio,hypoproteinemia and low PTA.5.One week after admission,the patients with thrombocytopenia,bilirubin rebound,increased bile acid and hyponatremia indicated a poor prognosis.