Hepatology:粒细胞集落刺激因子治疗激素无应答性重症酒精性肝炎的疗效

2019-02-20 朱倩,牛俊奇 临床肝胆病杂志

重症酒精性肝炎(SAH)通常是一种具有高死亡率,对类固醇治疗应答有限的进展性疾病。对于类固醇无反应性SAH(第7天,Lille-score>0.45)的管理方案有限。研究者评估了粒细胞集落刺激因子(G-CSF)在类固醇无应答者中的有效性和安全性。

重症酒精性肝炎(SAH)通常是一种具有高死亡率,对类固醇治疗应答有限的进展性疾病。对于类固醇无反应性SAH(第7天,Lille-score>0.45)的管理方案有限。研究者评估了粒细胞集落刺激因子(G-CSF)在类固醇无应答者中的有效性和安全性。

于2013年3月-2016年6月展开了一项随机、双盲、单中心试验(NCT01820208),对象是获得病理证实,并对40 mg/d泼尼松龙治疗无应答的SAH患者。这些患者被随机分配到G-CSF治疗组(30 0μg/d,给药5 d后,300 μg/3 d 直至28 d)或安慰剂组。对泼尼松龙治疗应答的SAH患者继续泼尼松治疗。在430例SAH患者中,132例接受了类固醇治疗。其中33例(25%)为无应答者,被随机分为G-CSF组或安慰剂组(每组14例)。2组基线特征具有可比性。28 d死亡率具有组间可比性(21.4%,G-CSF组;28.6%,安慰剂组;P=0.69)。

90 d时, G-CSF组终末期肝病模型(MELD)评分从24.6±3.9降至19.4±3.7 (P=0.002),Maddrey判别函数从74.8±22.8降至57.4±31 (P=0.26)。 G-CSF组感染率较安慰剂组降低(28% vs 71%, P<0.001),以及90 d死亡率也低于安慰剂组(35.7% vs 71.4%, P=0.04)。在Cox回归分析中,接受G-CSF ( HR=0.37, SD: -0.14~0.98, P=0.04)以及高基线血清肌酐水平(HR=4.12, SD: 1.7~10.3, P=0.002)预测类固醇无应答性SAH患者的90 d预后。患者对G-CSF耐受良好,无重大不良事件。约1/4的SAH患者对皮质类固醇治疗无应答,给予G-CSF是安全的且有助于降低这些患者的疾病严重程度及90 d死亡率。

原始出处:Saggere Muralikrishna Shasthry, Manoj Kumar Sharma, Varsha Shasthry, et al. Efficacy of g‐csf in the management of steroid‐nonresponsive severe alcoholic hepatitis: a double‐blind randomized controlled trial. Hepatology. 21 January 2019

 

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1758737, encodeId=80451e58737b9, content=<a href='/topic/show?id=1a675894241' target=_blank style='color:#2F92EE;'>#无应答#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58942, encryptionId=1a675894241, topicName=无应答)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=71ca37362043, createdName=12498717m78(暂无昵称), createdTime=Sun Nov 10 09:40:00 CST 2019, time=2019-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1673473, encodeId=4f1916e3473c3, content=<a href='/topic/show?id=757b954e922' target=_blank style='color:#2F92EE;'>#酒精性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95479, encryptionId=757b954e922, topicName=酒精性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=398f26933958, createdName=huiwelcome, createdTime=Sun Jul 28 02:40:00 CST 2019, time=2019-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1427299, encodeId=9559142e29980, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Fri Feb 22 14:40:00 CST 2019, time=2019-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540358, encodeId=81641540358b3, content=<a href='/topic/show?id=9aa195483ab' target=_blank style='color:#2F92EE;'>#酒精性肝炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95483, encryptionId=9aa195483ab, topicName=酒精性肝炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5b1413208885, createdName=xue8606, createdTime=Fri Feb 22 14:40:00 CST 2019, time=2019-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032076, encodeId=4c0310320e6c8, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Thu Feb 21 02:40:00 CST 2019, time=2019-02-21, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1758737, encodeId=80451e58737b9, content=<a href='/topic/show?id=1a675894241' target=_blank style='color:#2F92EE;'>#无应答#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58942, encryptionId=1a675894241, topicName=无应答)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=71ca37362043, createdName=12498717m78(暂无昵称), createdTime=Sun Nov 10 09:40:00 CST 2019, time=2019-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1673473, encodeId=4f1916e3473c3, content=<a href='/topic/show?id=757b954e922' target=_blank style='color:#2F92EE;'>#酒精性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95479, encryptionId=757b954e922, topicName=酒精性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=398f26933958, createdName=huiwelcome, createdTime=Sun Jul 28 02:40:00 CST 2019, time=2019-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1427299, encodeId=9559142e29980, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Fri Feb 22 14:40:00 CST 2019, time=2019-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540358, encodeId=81641540358b3, content=<a href='/topic/show?id=9aa195483ab' target=_blank style='color:#2F92EE;'>#酒精性肝炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95483, encryptionId=9aa195483ab, topicName=酒精性肝炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5b1413208885, createdName=xue8606, createdTime=Fri Feb 22 14:40:00 CST 2019, time=2019-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032076, encodeId=4c0310320e6c8, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Thu Feb 21 02:40:00 CST 2019, time=2019-02-21, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1758737, encodeId=80451e58737b9, content=<a href='/topic/show?id=1a675894241' target=_blank style='color:#2F92EE;'>#无应答#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58942, encryptionId=1a675894241, topicName=无应答)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=71ca37362043, createdName=12498717m78(暂无昵称), createdTime=Sun Nov 10 09:40:00 CST 2019, time=2019-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1673473, encodeId=4f1916e3473c3, content=<a href='/topic/show?id=757b954e922' target=_blank style='color:#2F92EE;'>#酒精性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95479, encryptionId=757b954e922, topicName=酒精性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=398f26933958, createdName=huiwelcome, createdTime=Sun Jul 28 02:40:00 CST 2019, time=2019-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1427299, encodeId=9559142e29980, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Fri Feb 22 14:40:00 CST 2019, time=2019-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540358, encodeId=81641540358b3, content=<a href='/topic/show?id=9aa195483ab' target=_blank style='color:#2F92EE;'>#酒精性肝炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95483, encryptionId=9aa195483ab, topicName=酒精性肝炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5b1413208885, createdName=xue8606, createdTime=Fri Feb 22 14:40:00 CST 2019, time=2019-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032076, encodeId=4c0310320e6c8, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Thu Feb 21 02:40:00 CST 2019, time=2019-02-21, status=1, ipAttribution=)]
    2019-02-22 gwc384
  4. [GetPortalCommentsPageByObjectIdResponse(id=1758737, encodeId=80451e58737b9, content=<a href='/topic/show?id=1a675894241' target=_blank style='color:#2F92EE;'>#无应答#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58942, encryptionId=1a675894241, topicName=无应答)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=71ca37362043, createdName=12498717m78(暂无昵称), createdTime=Sun Nov 10 09:40:00 CST 2019, time=2019-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1673473, encodeId=4f1916e3473c3, content=<a href='/topic/show?id=757b954e922' target=_blank style='color:#2F92EE;'>#酒精性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95479, encryptionId=757b954e922, topicName=酒精性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=398f26933958, createdName=huiwelcome, createdTime=Sun Jul 28 02:40:00 CST 2019, time=2019-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1427299, encodeId=9559142e29980, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Fri Feb 22 14:40:00 CST 2019, time=2019-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540358, encodeId=81641540358b3, content=<a href='/topic/show?id=9aa195483ab' target=_blank style='color:#2F92EE;'>#酒精性肝炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95483, encryptionId=9aa195483ab, topicName=酒精性肝炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5b1413208885, createdName=xue8606, createdTime=Fri Feb 22 14:40:00 CST 2019, time=2019-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032076, encodeId=4c0310320e6c8, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Thu Feb 21 02:40:00 CST 2019, time=2019-02-21, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1758737, encodeId=80451e58737b9, content=<a href='/topic/show?id=1a675894241' target=_blank style='color:#2F92EE;'>#无应答#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58942, encryptionId=1a675894241, topicName=无应答)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=71ca37362043, createdName=12498717m78(暂无昵称), createdTime=Sun Nov 10 09:40:00 CST 2019, time=2019-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1673473, encodeId=4f1916e3473c3, content=<a href='/topic/show?id=757b954e922' target=_blank style='color:#2F92EE;'>#酒精性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95479, encryptionId=757b954e922, topicName=酒精性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=398f26933958, createdName=huiwelcome, createdTime=Sun Jul 28 02:40:00 CST 2019, time=2019-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1427299, encodeId=9559142e29980, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Fri Feb 22 14:40:00 CST 2019, time=2019-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540358, encodeId=81641540358b3, content=<a href='/topic/show?id=9aa195483ab' target=_blank style='color:#2F92EE;'>#酒精性肝炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95483, encryptionId=9aa195483ab, topicName=酒精性肝炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5b1413208885, createdName=xue8606, createdTime=Fri Feb 22 14:40:00 CST 2019, time=2019-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032076, encodeId=4c0310320e6c8, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Thu Feb 21 02:40:00 CST 2019, time=2019-02-21, status=1, ipAttribution=)]
    2019-02-21 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

相关资讯

DIABETOLOGIA:美国女性中循环催乳素浓度和2型糖尿病风险如何?

催乳素是一种多功能激素,在实验研究中,其功能涉及调节胰岛素敏感性和葡萄糖稳态。然而,关于催乳素的循环浓度是否与2型糖尿病的风险相关仍然不确定。 研究人员分析了护士健康研究(NHS)和NHSII中循环催乳素浓度与2型糖尿病风险之间的前瞻性关系,并进行了长达22年的随访。使用免疫测定法测量总血浆催乳素,血液样本来源为在基线血液采集中的8615名无2型糖尿病和心血管疾病的女性(NHS 1989-1

Brit J Cancer:激素原发性多病灶前列腺癌和匹配的淋巴结转移转录组探索

目前对原发性前列腺癌(PC)预测能力的不足将会导致该疾病发生转移,同样导致良性PCs的过度治疗和恶性PCs的治疗不足。最近,有研究人员探索了多病灶激素原发性PC转移过程发生过程中的转录变化情况。研究人员使用了RNA测序的方法分析了23个激光显微切割原发性PC病灶位点和23个临近的正常前列腺组织样本,以及9个淋巴结转移位点。这些样本来自于10名激素原发性PC患者,并利用差异基因表达分析和聚类分析鉴定

Int J Obes:晚上更易暴饮暴食,且压力促进食欲

《国际肥胖杂志》上的一份报告提示,晚上是吃得过多的高危时间,尤其是当你有压力时,很容易暴饮暴食。

Pharmacotherapy:前列腺癌患者雄激素剥夺治疗相关的主要长期副作用有哪些?

2018年10月,美国学者发表在《Pharmacotherapy》的一项研究,考察了前列腺癌男性雄激素剥夺治疗(ADT)相关的主要长期副作用风险。

Gastroenterology:溃疡性结肠炎激素无应答:肠外甲氨蝶呤是否有效?

发表于《Gastroenterology》上的一项研究表明,对糖皮质激素无应答或缓解的溃疡性结肠炎(UC),肠外甲氨蝶呤不优于安慰剂。

Neurology:激素对动脉瘤压迫视神经的疗效

视野缺损,原因为巨大颈动脉-眼动脉瘤压迫右侧视神经。