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摘要：
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摘要：目的 观察糖皮质激素（glucocorticoids，GC）治疗酒精性肝炎（alcoholic hepatitis，
AH）的临床疗效。方法 回顾性分析2019年1月至2023年3月新疆维吾尔自治区人民医院收
治的44例AH患者的临床资料，根据治疗方案是否使用GC治疗分为GC组（16例）及非GC
组（28例）。收集的指标包括丙氨酸氨基转移酶（alanine transaminase，ALT）、天门冬
氨酸氨基转移酶（aspartate amino transferase，AST）、总胆红素（total bilirubin，TBil）、
国际标准化比值（international normalized ratio，INR）、白蛋白（albumin，ALB）、球
蛋白（globulin，GLO）、γ-谷氨酰转肽酶（gamma-glutamyltransferase，GGT）、白细胞
计数（white blood cell count，WBC）、中性粒细胞比例（neutrophil ratio，NEUT）、血
小板计数（platelet count，PLT）、平均红细胞体积（mean corpuscular volume，MCV）、
肌酐（creatinine，Cr）、活化部分凝血活酶时间（activated partial thromboplastin time，
APTT）、凝血酶原时间（prothrombin time，PT）、凝血酶原活动度（prothrombintime
activity，PTA），计算MELD评分、Maddrey判别函数（maddrey’s discriminant function，
mDF），计算GC组与非GC组28 d、90 d和180 d存活率，观察GC组治疗0 d、3 d、7 d的
临床指标变化，并分析合并感染的AH患者使用GC治疗是否影响短期预后。结果 ①GC
组患者年龄小于非GC组 [（46.63 ± 7.98）岁 vs （54.89 ± 11.40）岁]，基线TBil（中位
数：300.04 μmol/L vs 101.72 μmol/L）、GGT（中位数：305.50 U/L vs 96.00 U/L）、WBC
[（14.45 ± 8.69）× 109
/L vs （8.67 ± 4.58）× 109
/L]、NEUT（中位数：6.87 × 109
/L vs 9.36 ×
109
/L）、MCV [（106.09 ± 8.85）fL vs（99.43 ± 9.45）fL] 均高于非GC组患者，INR（1.62 ±
0.35 vs 2.04 ± 0.91）和PT [（19.01 ± 3.39）s vs（22.63 ± 7.63）s] 低于非GC组患者，差异均
有统计学意义（P均＜ 0.05）。②GC组患者90 d生存率显著高于非GC组 [81.3%（13/16）
vs 46.4%（13/28）；χ
2
= 1.182，P = 0.024]，GC组和非GC组患者28 d生存率分别为93.7%
（15/16）、64.3%（18/28），差异无统计学意义（χ
2
= 3.274，P = 0.070），GC组和非
GC组患者180 d生存率分别为56.3%（9/16）、39.3%（11/28），差异无统计学意义（χ
2
=
1.182，P = 0.277）。③接受GC治疗满3 d及7 d患者的临床指标（包括TBil、GLO、ALB）
较基线有明显改善 [TBil：中位数 198.50 μmol/L vs 180.34 μmol/L vs 311.00 μmol/L；GLO：
（33.12 ± 5.68）g/L vs （30.82 ± 6.45）g/L vs （38.69 ± 9.36）g/L；ALB：（28.66 ± 3.93）g/L
vs （31.66 ± 3.93）g/L vs （27.20 ± 2.99）g/L；P均＜ 0.05]。④GC组中合并感染和未合
并感染患者180 d生存率分别为44.4%（4/9）、55.6%（5/9），差异无统计学意义（P =
0.358），非GC组中合并感染和未合并感染患者180 d生存率分别为63.6 %（7/11）、36.4%
（4/11），差异无统计学意义（P = 0.671）。结论 GC可改善AH患者短期预后。对GC疗
效的早期评估（治疗满3 d）可提前评估患者的临床疗效，对于合并感染的AH患者在有效
抗生素治疗前提下可予以糖皮质激素治疗。
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Abstract: Objective To observe the clinical efficacy of glucocorticoids (GC) in the treatment
of alcoholic hepatitis (AH). Methods The clinical data of 44 patients with AH in the People’s
Hospital of Xinjiang Uygur Autonomous Region from January 2019 to March 2023 were
retrospectively analyzed and divided into GC group (16 cases) and non-GC group (28 cases)
according to the treatment plan. The levels of alanine aminotransferase (ALT), aspartate
aminotransferase (AST), total bilirubin (TBil), international normalized ratio (INR), albumin
(ALB), globulin (GLO), gamma glutamyltransferase (GGT), white blood cell count (WBC),
neutrophil ratio (NEUT), platelet count (PLT), mean corpuscular volume (MCV), creatinine
(Cr), activated partial thromboplastin time (APTT), prothrombin time (PT) and prothrombin
activity (PTA) were recorded. MELD score and Madrey’s discriminant function (mDF) were
calculated. The survival rates of patients in GC group and non-GC group at 28 d, 90 d and
180 d were calculated, and the changes of clinical indexes in GC group at 0 d, 3 d and 7 d
were observed. Whether the use of GC treatment in AH patients with co-infection affected the
short-term prognosis were analyzed. Results ①Patients in GC group were younger than those
in non-GC group [(46.63 ± 7.98) years vs (54.89 ± 11.40) years], the baseline level of TBil
(median: 300.04 μmol/L vs 101.72 μmol/L), GGT (median: 305.50 U/L vs 96.00 U/L), WBC
[(14.45 ± 8.69) × 109
/L vs (8.67 ± 4.58) × 109
/L], NEUT (median: 6.87 × 109
/L vs 9.36 × 109
/L)
and MCV [(106.09 ± 8.85) fL vs (99.43 ± 9.45) fL] of patients in GC group were higher than
those in non-GC group, the baseline level of INR (1.62 ± 0.35 vs 2.04 ± 0.91) and PT [(19.01 ± 3.39) s
vs (22.63 ± 7.63) s] were lower than those in non-GC group, the differences were statistically
significant (all P ＜ 0.05). ②The 90 d survival rate of patients in GC group was significantly
higher than that of non-GC group [81.3% (13/16) vs 46.4% (13/28); χ
2
= 1.182, P = 0.024].
The 28 d survival rate of patients in GC group and non-GC group were 93.7% (15/16) and
64.3% (18/28), respectively, the differences were not statistically significant (χ
2
= 3.274, P =
0.070). The 180 d survival rate of patients in GC group and non-GC group were 56.3% (9/16)
and 39.3% (11/28), respectively, the differences were not statistically significant (χ
2
= 1.182,
P = 0.277). ③The clinical indicators including TBil (median: 198.50 μmol/L vs 180.34 μmol/L
vs 311.00 μmol/L), GLO [(33.12 ± 5.68) g/L vs (30.82 ± 6.45) g/L vs (38.69 ± 9.36) g/L]
and ALB [(28.66 ± 3.93) g/L vs (31.66 ± 3.93) g/L vs (27.20 ± 2.99) g/L] after GC treatment
for 3 days and 7 days improved significantly compared with 0 days (all P ＜ 0.05). ④The
180 d survival rate of co-infected and uncoinfected patients in GC group were 44.4% (4/9)
and 55.6% (5/9), respectively, the difference was not statistically significant (P = 0.358).
The 180 d survival rate of co-infected and uncoinfected patients in non-GC group were 63.6 %
(7/11) and 36.4% (4/11), respectively, the difference was not statistically significant (P =
0.671). Conclusions The use of GC can improve the short-term prognosis of patients with
AH. Early assessment of the efficacy of GC (3 days of treatment) is beneficial for early
assessment of the clinical efficacy of patients. AH patients with co-infection can be treated
with glucocorticoids under the premise of effective antibiotic therapy.
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