The Exploration Of Clinical Effect About Prednisolone In HBV-associated Acute-on-chronic Liver Failure

BackgroundHBV-ACLF is a serious threat to the lives of patients with hepatitis B disease and occupy a large proportion in liver failure, it can lead to high fatality rate, and no special efficacy treatment.With the widely application of antiviral drugs in clinical, the mortality of HBV-ACLF is declining,but there are still many difficult problems. For example, how to ease the inflammation of the liver cells,how to Reduce bilirubin and Improve the patient’s early symptoms,how to improve survival rates is the one probleme should be explored in depth. Recent years, there are many drugs and new technologies used to reduce the bilirubin have appeared in the clinical, however, the efficacy and safety of these treatments are unsatisfactory. For the patients with poor effect under medical treatment and artificial liver treatment, the Final method is liver transplantation.In fact,The treatment of HBV-ACLF is a very difficult process, it needs a long time and spends a lot, but gets only poor efficacy, many patients can not be under tremendous economic pressure to give up treatment at last. Therefore,looking for a safe, effective and economic treatment of Strategy is of great significance. Glucocorticoid has strong founction of anti-inflammator,immuno-suppression, and protection of the liver cell, is the ideal drug theoretically applied to liver failure.Because glucocorticoid has quite a lot side effects, especially the acceleration replication of HBV, the clinical application of it was extremely limited. Since the the NAs advent, glucocorticoid in HBV-ACLF has once again aroused extensive attention from scholars.ObjectiveExplore the application value of small doses of prednisolone in the HBV ACLF, provide a reliable basis for clinical treatment of HBV-ACLF.MethodsTo chose HBV-ACLF patients in the Department of Infectious Diseases of First Affiliated Hospital of Zhengzhou University in May2006to May2011, a total of41cases,25males and16females, age from24to58years, Selected41patients were randomly divided into treatment and control groups, group2patients were treated with hepatoprotective, anti-virus, prevent infection, infusion of plasma proteins, the basic treatment measures for preventing upper gastrointestinal bleeding. Treatment group in addition to the basic treatment, In the treatment of the starting point given prednisolone20mg and every two weeks reduction5mg until the withdrawal; control group in addition to the basic treatment,giving placebo in the treatment of the starting point.DBiL,TBiL,ALT,AST,PTA,blood,kidney function and electrolytes are measured weekly.Before and after treatment were measured weekly serum TBiL, DBiL, ALT, AST, PTA, blood routine, renal function and electrolytes. Every four weeks observe HBV-DNA, HBsAg and HBeAg.We apply SPSS17.0to Complete statistical analysis, all data werere ported as mean士SD, quantitative data were analyzed using t test or repeated measure analysis of variance, rates were compared using X2test, inspection level a=0.05.ResultsAfter the treatment, comparing with the controlled group, the treatment group can significantly improve the clinical symptoms (Abdominal distension: t=3.151, p<0.005; Fatigue: t=3.456,p<0.002; Anorexia:t=2.780,p<0.010), accelerate the normalization of the aminotransferase(χ2=7.791,p<0.010), improve treatment efficiency (χ2=15.680,p<0.010) significantly and reduce the level of serum TBil(F=23.560, p=0.000) after treatmen. But it is not helpful to promote the PTA level(t=0.439, p>0.663). In the case of effective anti-HBV therapy and sufficient to prevent complications and glucocorticoid side effects, the change of HBV-DNA, HBsAg and HBeAg between two groups showed no significant difference (HBsAg: t=1.236,p0.200; HBeAg:t=0.983,p>0.200; HBV-DNA:t=1.554,p>0.100)Conclusion1.The application of small doses of prednisolone can improve HBV-ACLF patients with fatigue, anorexia, abdominal distension and other symptoms, promote the regression of bilirubin and accelerated transaminase normalization, but for the PTA has no special significance.2. Small dose of prednisolone can improve transaminase normalization rates and treatment efficiency in patients with HBV-ACLF.3.Combination of effective anti-HBV therapy, no significant difference between the two groups of HBV-DNA, HBsAg and HBeAg in the degree of change after treatment, this treatment has better security, spends less, and has the possibility of further research and promotion in the clinical.