Effect of oral and intravenous Prednisolone on infants with biliary atresia after hepatoportoenterostomy
10.3760/cma.j.issn.2095-428X.2015.23.010
- VernacularTitle:口服与静脉注射泼尼松龙对胆道闭锁患儿术后疗效的影响
- Author:
Kun DONG
;
Tiquan YANG
;
Chunqiang DONG
;
Qiang LIU
;
Chao CHEN
;
Cheng ZHANG
- Publication Type:Journal Article
- Keywords:
Biliary atresia;
Steroid;
Intravenous;
Oral
- From:
Chinese Journal of Applied Clinical Pediatrics
2015;30(23):1795-1797
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare oral with intravenous Prednisolone after hepatoportoenterostomy in improving biliary drainage and survival with the native liver.Methods Forty-nine cases of biliary atresia were conducted from January to December in 2012.Participants were randomized to receive oral Prednisolone (group A) or intravenous Prednisolone (group B) on the fifth day of posthepatoportoenterostomy (the other treatments were same,including intravenous injection of Cefoperazone for 2 weeks, choleretic treatment, etc.).The initial dose was 4 mg/(kg · d), and it was reduced by half per 3 days, until 1 mg/(kg · d).Then Prednisolone was administered orally with 1 mg/(kg · d)for 3 months.The primary end points were the total bilirubin level(TBIL) and the percentage of cholangitis in 6 months of posthepatoportoenterostomy.Secondary outcome was survival with native liver in 24 months after hepatoportoenterostomy.Results The ages of group A and group B were(98 ±33) d and(105 ±36) d,TBIL of them were (158.36 ± 55.22) μmol/L and (160.11 ±43.12) μmol/L,and there were no statistical differences between the 2 groups before surgery (t =-0.663,-0.123, all P ＞ 0.05).In the first 2 months after operation, the mean TBIL value of group A was higher than that of group B (in the first month after surgery ,the TBIL quartiles P25 ,P50 ,P75 of group A were 105 μmol/L, 152 μmol/L, 236 μmol/L, and the quartiles of group B were 40 μmol/L, 74 μmol/L, 99 μmol/L.In the second month after surgery,the TBIL quartiles of group A were 67 μmol/L, 103 μmol/L, 144 μmol/L,and the quartiles of group B were 39 μmol/L,64 μmol/L, 196 μmol/L) (all P ＜ 0.05).The morbidity of cholangitis which occurred in group A(56.0％ ,60.0％) was higher than that in group B (25.0％, 29.2％) (x2 =4.871,4.705, all P ＜ 0.05).However,from the 3rd to 6th months,there was no statistical difference between group A and group B(all P ＞ 0.05).Transplant-free survival was 44.0％ in group A and 47.7％ in group B 24 months after operation, and there was no statistical difference(x2 =1.007 ,P ＞ 0.05).Conclusions Therapy of intravenous Prednisolone following portoenterostomy may be more beneficial in bile drainage than oral method,but it's of no use to improve survival.
