CAJ | 학술논문

目的：观察糖皮质激素降阶梯治疗联合抗病毒治疗对早期重症乙型肝炎的阻断效果及其安全性。方法选取该科治疗的早期重症肝炎患者49例，分为观察组（n＝24）和对照组（n＝25）。对照组采用常规综合治疗，观察组在常规治疗基础上联合糖皮质激素降阶梯治疗。观察并比较两组患者肝功能、凝血酶原等指标的改善以及临床症状、病死率的差异。结果观察组和对照组的病死率分别为16．7％和32．0％，差异有统计学意义（ P＜0．05）。观察组消化道改善，黄疸消退时间均短于对照组（ P＜0．05），而消化道出血、感染率差异无统计学意义（P＞0．05）。治疗1个月后，两组患者的总胆红素（TBIL）、丙氨酸氨基转移酶（ALT）、凝血酶原时间（PT）及凝血酶原活动度（PTA）均较治疗前显著改善（P＜0．05），且观察组上述指标的改善显著优于对照组（P＜0．05）。两组存活患者治疗后乙型肝炎病毒（HBV） DNA较治疗前显著降低（P＜0．05），且 HBV DNA、转阴率组间比较差异无统计学意义（P＞0．05）。结论糖皮质激素降阶梯联合抗病毒治疗早期重症肝炎是一种有效、安全的方法，可阻断重型肝炎发展，降低患者病死率。
목적：관찰당피질격소강계제치료연합항병독치료대조기중증을형간염적조단효과급기안전성。방법선취해과치료적조기중증간염환자49례，분위관찰조（n＝24）화대조조（n＝25）。대조조채용상규종합치료，관찰조재상규치료기출상연합당피질격소강계제치료。관찰병비교량조환자간공능、응혈매원등지표적개선이급림상증상、병사솔적차이。결과관찰조화대조조적병사솔분별위16．7％화32．0％，차이유통계학의의（ P＜0．05）。관찰조소화도개선，황달소퇴시간균단우대조조（ P＜0．05），이소화도출혈、감염솔차이무통계학의의（P＞0．05）。치료1개월후，량조환자적총담홍소（TBIL）、병안산안기전이매（ALT）、응혈매원시간（PT）급응혈매원활동도（PTA）균교치료전현저개선（P＜0．05），차관찰조상술지표적개선현저우우대조조（P＜0．05）。량조존활환자치료후을형간염병독（HBV） DNA교치료전현저강저（P＜0．05），차 HBV DNA、전음솔조간비교차이무통계학의의（P＞0．05）。결론당피질격소강계제연합항병독치료조기중증간염시일충유효、안전적방법，가조단중형간염발전，강저환자병사솔。
Objective Observe the efficacy and safety of glucocorticoid deescalation combined antiviral therapy on severe hepati‐tis B .Methods Forty‐nine patients with early severe hepatitis were selected and divided them into observation group(n=24) and control group (n=25) randomly .Control group were given the conventional synthetic therapy while observation group were given conventional synthetic therapy combined glucocorticoid deescalation therapy .Then compare the differences of TBIL ,ALT ,PTA be‐fore and after treatment ,and the improvement time of syndrome and death rate between two groups .Results The death rate in ob‐servation group and control group were 16 .7% and 32 .0% respectively(P<0 .05) ,the improvement time of syndrome in observa‐tion group were shorten than control group(P<0 .05) ,and there was no statistical difference in bleeding and infection rate between two groups(P>0 .05) .After the treatment ,the TBIL ,ALT ,PT were improved in both two groups(P<0 .05) .But the observation group had better improvement than control group ,the difference had statistical significance(P<0 .05) .After treatment ,the changes of HBV DNA between two groups showed no significant difference(P> 0 .05) .Conclusion Glucocorticoid deescalation therapy could decrease the death rate ,shorten the syndrome lasting time in treating severe hepatitis B .It was an effective and safety meth‐od .