在严重的酒精相关性肝炎中,皮质类固醇的生存益处归因于大型多中心队列中的临床和治疗差异
Claire Durkin1, Douglas E Schaubel2, David E Kaplan1,3
1Department of Medicine, Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Clinical and translational gastroenterology
|December 2, 2024
概括
在经过调整的分析中,皮质类固醇对与酒精相关的严重肝炎 (AH) 患者的生存没有益处. 治疗持续时间对响应患者的生存率没有影响,这表明目前的指导方针可能需要重新评估.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 胃肠病学 胃肠病学
- 临床药理学 临床药理学
背景情况:
- 严重的酒精相关性肝炎 (AH) 治疗指南建议使用皮质类固醇.
- 皮质类固醇对AH的生存益处仍然存在争议,因为证据不一致.
研究的目的:
- 评估皮质类固醇治疗对严重AH全因生存的影响.
- 确定与皮质类固醇使用相关的因素及其持续时间对生存的影响.
主要方法:
- 从2005年到2020年,对严重的AH患者 (马德雷判别函数≥32) 的回顾性队列研究.
- 分析所有原因的生存率,临床/心理社会因素和对治疗有反应的患者的皮质类固醇持续时间 (里尔分数<0.45).
主要成果:
- 皮质类固醇在41.37%的严重AH住院治疗中被使用.
- 经过调整后的分析显示,皮质类固醇没有显著的生存益处 (aHR = 1.01,P = 0.818).
- 精神病学咨询与死亡率降低有关 (aHR = 0.67,P < 0.001);治疗持续时间没有显示生存差异.
结论:
- 在严重的AH中,皮质类固醇的使用率低于最佳,在调整患者特征后,没有证明生存益处.
- 在利尔评分定义的响应者中,在较短和较长的皮质类固醇持续时间之间没有观察到生存差异.
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