用或不用利法西明的抗生素治疗肝硬化重症患者的急性肝脑病:双盲随机对照 (ARiE) 试验
Anand V Kulkarni1, Mahathi Avadhanam1, Puja Karandikar1
1Department of Hepatology, AIG Hospitals, Hyderabad, India.
The American journal of gastroenterology
|November 9, 2023
概括
将利法西明添加到抗生素中并没有改善大多数肝脏脑病变的ICU患者的结果. 然而,它在一个特定的非补偿性肝硬化患者小组中显示出生存益处.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
背景情况:
- 在ICU中患有肝硬化症的重症患者经常接受宽谱抗生素.
- 在这种人群中,额外的利法西明在治疗急性明显肝脑病变 (HE) 的作用尚不清楚.
研究的目的:
- 为了研究rifaximin与抗生素相结合的协同效应与单独抗生素在ICU患者急性公开的HE.
- 为了比较两个治疗组之间的HE分辨率,分辨时间,死亡率和感染率.
主要方法:
- 一项双盲试验随机选择了184名ICU患者,这些患者有明显的HE,接受单独抗生素或抗生素加rifaximin.
- 评估的结果包括HE逆转,HE解决的时间,住院死亡率和医院感染.
- 对患有不补偿性肝硬化和急性至慢性肝衰竭的患者进行了亚组分析.
主要成果:
- 在各组之间,在HE解决率 (44.6%与46.7%) 或解决时间方面没有发现显著差异.
- 住院死亡率相似 (62%对50%),医院感染率没有显著差异.
- 利法西明显著降低了不补偿性肝硬化患者的住院死亡率 (HR:0.39),但不是急性-慢性肝衰竭患者.
结论:
- 与广谱抗生素一起添加的利法西明并不能改善明显的HE逆转或降低严重病情的肝硬化患者的死亡率.
- 利法西明可以为特定的亚组提供生存益处:患有不补偿性肝硬化症的患者,可能通过减少医院感染.
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