合理应用糖皮质激素治疗乙型肝炎病毒相关肝衰竭
摘要
乙型肝炎病毒(HBV)相关肝衰竭的治疗一直是临床工作中的难题。抑制疾病前期过强的免疫反应对肝细胞的破坏和促进疾病后期肝细胞的再生是治疗的关键,而糖皮质激素(GC)作为传统免疫抑制剂却在临床应用中备受争议。通过动态监测炎性因子水平变化来判断患者所处免疫阶段,并在此前提下合理使用GC能更好地发挥激素治疗效果,改善患者预后。该文就国内外有关GC在乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)中的作用机制及其应用原则的研究进展作一综述。
引文
[1] Hernaez R,Sola E,Moreau R,et al.Acute-on-chronic liver failure:an update[J].Gut,2017,66:541-553.
2 中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2012年版)[J].中华肝脏病杂志,2013,21:177-183.
3 Laleman W,Verbeke L,Meersseman P,et al.Acute-onchronic liver failure:current concepts on definition,pathogenesis,clinical manifestations and potential therapeutic interventions[J].Expert Rev Gastroenterol Hepatol,2011,5:523-537,537.
4 王宇明,李兰娟.《肝衰竭诊治指南(2012年版)》治疗进展解读与探讨[J].中华临床感染病杂志,2013,6:77-80.
5 叶一农,高志良.乙型肝炎肝衰竭发生机制中的三重打击[J].中华肝脏病杂志,2009,17:638-640.
6 Wang X,Ning Q.Immune-mediated liver failure[J].EXCLI J,2014,13:1131-1144.
7 Alam A,Chun Suen K,Ma D,et al.Acute-on-chronic liver failure:recent update[J].J Biomed Res,2017,31:283-300.
8 Melgaco JG,Soriani FM,Sucupira PH,et al.Changes in cellular proliferation and plasma products are associated with liver failure[J].World J Hepatol,2016,8:1370-1383.
9 Greulich F,Hemmer MC,Rollins DA,et al.There goes the neighborhood:Assembly of transcriptional complexes during the regulation of metabolism and inflammation by the glucocorticoid receptor[J].Steroids,2016,114:7-15.
10 鱼康康,李宁,施光峰.在争议中迈步向前:慢加急性肝衰竭研究进展[J].肝脏,2014,22:208-210.
11 Fujiwara K,Yasui S,Yonemitsu Y,et al.Efficacy of combination therapy of antiviral and immunosuppressive drugs for the treatment of severe acute exacerbation of chronic hepatitis B[J].J Gastroenterol,2008,43:711-719.
12 聂青和.糖皮质激素在肝衰竭治疗中的地位[J].中华肝脏病杂志,2012,20:414-415.
13 杨文龙,刘武,李涛.小剂量糖皮质激素治疗早期重型肝炎临床疗效观察[J].国际流行病学传染病学杂志,2005,32:265-266.
14 Polson J,Lee WM,Disease AAFOL.AASLD position paper:the management of acute liver failure:update 2011[J].Nat Guid Clear,2012,65:1433-1441.
15 Sarin SK,Kumar A,Almeida JA,et al.Acute-on-chronic liver failure:consensus recommendations of the Asian Pacific Association for the study of the liver(APASL)[J].Hepatol International,2014,8:453-471.
16 杨晓鲲,徐贵森.糖皮质激素治疗乙型肝炎病毒相关性肝衰竭疗效的Meta分析[J].解放军医学杂志,2013,38:581-585.
17 He B,Zhang Y,LüMH,et al.Glucocorticoids can increase the survival rate of patients with severe viral hepatitis B:a metaanalysis[J].Eur J Gastroenterol Hepatol,2013,25:926-934.
18 张绍全,雷姿颖,陈俊峰,等.短程地塞米松不能提高乙型肝炎慢加急性肝衰竭生存率[J].中山大学学报:医学科学版,2014,35:67-73.
19 Listed N.Randomised trial of steroid therapy in acute liver failure.Report from the European Association for the Study of the Liver(EASL)[J].Gut,1979,20:620-623.
20 张辉艳,张绪清.糖皮质激素阻止肝衰竭发生与发展的机制[J].胃肠病学和肝病学杂志,2016,25:481-484.
21 洪亮,叶志勇,孙庆丰,等.慢加急性乙型肝炎肝衰竭并发症与预后的关系研究[J].中国微生态学杂志,2011,23:829-831.
22 刘明,张绪清,毛青.慢加急性肝衰竭前期的概念及预警模型[J].临床肝胆病杂志,2012,28:732-734.
23 张涛,吉婧,刘鹏,等.不同阶段HBV相关ACLF患者外周血DC及T淋巴细胞免疫功能特点研究[J].肝脏,2014,22:924-929.
24 Dong X,Gong Y,Zeng H,et al.Imbalance between circulating CD4+regulatory T and conventional T lymphocytes in patients with HBV-related acute-on-chronic liver failure[J].Liver Int,2013,33:1517-1526.
25 Nagy P,Kiss A,Schnur J,et al.Dexamethasone inhibits the proliferation of hepatocytes and oval cells but not bile duct cells in rat liver[J].Hepatology,1998,28:423-429.
26 Scheving LA,Buchanan R,Krause MA,et al.Dexamethasone modulates ErbB tyrosine kinase expression and signaling through multiple and redundant mechanisms in cultured rat hepatocytes[J].Am J Physiol Gastrointest Liver Physiol,2007,293:G552-G559.
27 Bao S,Zheng J,Li N,et al.Role of interleukin-23in monocytederived dendritic cells of HBV-related acute-on-chronic liver failure and its correlation with the severity of liver damage[J].Clin Res Hepatol Gastroenterol,2017,41:147-155.
28 罗光成,黄云丽,闫惠平,等.HBV相关慢加急性肝衰竭患者血清细胞因子水平与疾病预后的关系研究[J].检验医学,2014,29:26-30.
29 Wang K,Wu ZB,Ye YN,et al.Plasma interleukin-10:a likely predictive marker for hepatitis B virus-related acute-on-chronic liver failure[J].Hepat Mon,2014,14:e19370.
30 Bockmann JH,Dandri M,Luth S,et al.Combined glucocorticoid and antiviral therapy of hepatitis B virus-related liver failure[J].World J Gastroenterol,2015,21:2214-2219.
2 中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2012年版)[J].中华肝脏病杂志,2013,21:177-183.
3 Laleman W,Verbeke L,Meersseman P,et al.Acute-onchronic liver failure:current concepts on definition,pathogenesis,clinical manifestations and potential therapeutic interventions[J].Expert Rev Gastroenterol Hepatol,2011,5:523-537,537.
4 王宇明,李兰娟.《肝衰竭诊治指南(2012年版)》治疗进展解读与探讨[J].中华临床感染病杂志,2013,6:77-80.
5 叶一农,高志良.乙型肝炎肝衰竭发生机制中的三重打击[J].中华肝脏病杂志,2009,17:638-640.
6 Wang X,Ning Q.Immune-mediated liver failure[J].EXCLI J,2014,13:1131-1144.
7 Alam A,Chun Suen K,Ma D,et al.Acute-on-chronic liver failure:recent update[J].J Biomed Res,2017,31:283-300.
8 Melgaco JG,Soriani FM,Sucupira PH,et al.Changes in cellular proliferation and plasma products are associated with liver failure[J].World J Hepatol,2016,8:1370-1383.
9 Greulich F,Hemmer MC,Rollins DA,et al.There goes the neighborhood:Assembly of transcriptional complexes during the regulation of metabolism and inflammation by the glucocorticoid receptor[J].Steroids,2016,114:7-15.
10 鱼康康,李宁,施光峰.在争议中迈步向前:慢加急性肝衰竭研究进展[J].肝脏,2014,22:208-210.
11 Fujiwara K,Yasui S,Yonemitsu Y,et al.Efficacy of combination therapy of antiviral and immunosuppressive drugs for the treatment of severe acute exacerbation of chronic hepatitis B[J].J Gastroenterol,2008,43:711-719.
12 聂青和.糖皮质激素在肝衰竭治疗中的地位[J].中华肝脏病杂志,2012,20:414-415.
13 杨文龙,刘武,李涛.小剂量糖皮质激素治疗早期重型肝炎临床疗效观察[J].国际流行病学传染病学杂志,2005,32:265-266.
14 Polson J,Lee WM,Disease AAFOL.AASLD position paper:the management of acute liver failure:update 2011[J].Nat Guid Clear,2012,65:1433-1441.
15 Sarin SK,Kumar A,Almeida JA,et al.Acute-on-chronic liver failure:consensus recommendations of the Asian Pacific Association for the study of the liver(APASL)[J].Hepatol International,2014,8:453-471.
16 杨晓鲲,徐贵森.糖皮质激素治疗乙型肝炎病毒相关性肝衰竭疗效的Meta分析[J].解放军医学杂志,2013,38:581-585.
17 He B,Zhang Y,LüMH,et al.Glucocorticoids can increase the survival rate of patients with severe viral hepatitis B:a metaanalysis[J].Eur J Gastroenterol Hepatol,2013,25:926-934.
18 张绍全,雷姿颖,陈俊峰,等.短程地塞米松不能提高乙型肝炎慢加急性肝衰竭生存率[J].中山大学学报:医学科学版,2014,35:67-73.
19 Listed N.Randomised trial of steroid therapy in acute liver failure.Report from the European Association for the Study of the Liver(EASL)[J].Gut,1979,20:620-623.
20 张辉艳,张绪清.糖皮质激素阻止肝衰竭发生与发展的机制[J].胃肠病学和肝病学杂志,2016,25:481-484.
21 洪亮,叶志勇,孙庆丰,等.慢加急性乙型肝炎肝衰竭并发症与预后的关系研究[J].中国微生态学杂志,2011,23:829-831.
22 刘明,张绪清,毛青.慢加急性肝衰竭前期的概念及预警模型[J].临床肝胆病杂志,2012,28:732-734.
23 张涛,吉婧,刘鹏,等.不同阶段HBV相关ACLF患者外周血DC及T淋巴细胞免疫功能特点研究[J].肝脏,2014,22:924-929.
24 Dong X,Gong Y,Zeng H,et al.Imbalance between circulating CD4+regulatory T and conventional T lymphocytes in patients with HBV-related acute-on-chronic liver failure[J].Liver Int,2013,33:1517-1526.
25 Nagy P,Kiss A,Schnur J,et al.Dexamethasone inhibits the proliferation of hepatocytes and oval cells but not bile duct cells in rat liver[J].Hepatology,1998,28:423-429.
26 Scheving LA,Buchanan R,Krause MA,et al.Dexamethasone modulates ErbB tyrosine kinase expression and signaling through multiple and redundant mechanisms in cultured rat hepatocytes[J].Am J Physiol Gastrointest Liver Physiol,2007,293:G552-G559.
27 Bao S,Zheng J,Li N,et al.Role of interleukin-23in monocytederived dendritic cells of HBV-related acute-on-chronic liver failure and its correlation with the severity of liver damage[J].Clin Res Hepatol Gastroenterol,2017,41:147-155.
28 罗光成,黄云丽,闫惠平,等.HBV相关慢加急性肝衰竭患者血清细胞因子水平与疾病预后的关系研究[J].检验医学,2014,29:26-30.
29 Wang K,Wu ZB,Ye YN,et al.Plasma interleukin-10:a likely predictive marker for hepatitis B virus-related acute-on-chronic liver failure[J].Hepat Mon,2014,14:e19370.
30 Bockmann JH,Dandri M,Luth S,et al.Combined glucocorticoid and antiviral therapy of hepatitis B virus-related liver failure[J].World J Gastroenterol,2015,21:2214-2219.