The short-term efficacy of small dosage of dexamethasone therapy in chronic hepatitis B with tendency to severe hepatitis

Objective To evaluate the efficacy of small dosage dexamethasone therapy in chronic viral hepatitis B patients with tendency to severe hepatitis.Methods Sixty cases of chronic hepatitis B patients with tendency to severe hepatitis in the Third Affiliated Hospital of Sun Yat-sen University from July 2010 to November 2011 were randomly divided into the treatment group (n =30) and control group (n =30).The control group received comprehensive physical treatment and antiviral treatment with entecavir,while the treatment group was treated with dexamethasone therapy (10 mg/d,3 days,intravenous injection) on the basis of the above mentioned treatment.The serum alanine transaminase (ALT),total bilirubine (TBil),prothrombin time (PT),clinical improvement rate and hospitalization time between the two groups were compared during therapy at weeks 0,1,4,8,10 and 12.Results The serum ALT levels on admission were (561.6 ± 425.1) and (576.8 ± 437.8) U/L respectively.There were no significant statistical differences between the two groups(t =-0.36,P ＞ 0.05).After the treatment,ALT levels in two groups decreased with time.ALT in treatment group were all lower than control group from week 1 to week 10.However,at week 12,the serum ALT levels in 2 groups were(38.9 ± 10.9) and (40.6 ± 11.3) U/L respectively.There were no significant statistical differences between the two groups(t =-0.13,P ＞ 0.05).Compared to the control group,TBil decreased and PT shortened significantly in treatment group patients after therapy for 12 weeks.The serum TBil in treatment group at weeks 1,2,4,8,10 and 12 were (449.2± 185.3),(350.1 ± 194.8),(235.6±91.6),(189.6±64.7),(120.8± 56.9) and (74.6± 32.8) μmol/L,and were lower than control group (t =-7.20,-12.97,-17.52,-14.80,-11.60 and-10.71,P ＜ 0.05).The PT in treatment group at weeks 1,2,4,8,10 and 12 were(40.2 ± 6.7),(30.3 ± 10.6),(27.3 ± 5.9),(22.3 ± 6.4),(19.4 ± 6.5)and (17.3 ± 7.5)s,and were higher than control group (t =-6.05,-6.68,-8.48,-10.28,-6.60 and-4.69,P ＜0.05).The improvement rate in treatment group was higher than control group (86.7％:43.3％,x2 =0.02,P ＜0.05).The average hospitalization time in treatment group was shorter than control group(32.1 d vs 79.7 d,t =-17.27,P ＜ 0.05).Conclusions Short-term dexamethasone therapy in chronic hepatitis B patients with tendency to severe hepatitis can improve liver function,the clinical improvement rate and shorten the hospitalization time. Key words: Hepatitis B; Severe hepatitis; Glucocorticoid