Gastroenterology:晚期肝硬化长期使用诺氟沙星或可降低死亡率,且不会增加多重耐药菌感染的几率

2019-02-27 佚名 爱肝一生微课堂

近日,法国18家临床中心共同完成的一项随机对照研究(NORFLOCIR)表明:晚期肝硬化患者接受氟喹诺酮类药物诺氟沙星长期治疗,6个月生存率虽未得到显着提升,但诺氟沙星似乎可以增加腹水蛋白水平较低者的生存率,且可预防感染发生。

Tenofovir长期口服氟喹诺酮治疗对晚期肝硬化患者的影响一直存在争议。近日,法国18家临床中心共同完成的一项随机对照研究(NORFLOCIR)表明:晚期肝硬化患者接受氟喹诺酮类药物诺氟沙星长期治疗,6个月生存率虽未得到显着提升,但诺氟沙星似乎可以增加腹水蛋白水平较低者的生存率,且可预防感染发生。

该项双盲、安慰剂对照试验于2010年4月至2014年11月期间在法国的18家临床中心进行,共纳入291例Child-Pugh C级肝硬化患者。入组时,这些患者近期均未接受氟喹诺酮类药物治疗,被随机分配到400 mg诺氟沙星组(n=144)或安慰剂组(n=147),每日一次,持续6个月。

在最初6个月,每月对患者进行评估,之后分别于第9个月和第12个月评估一次。主要研究终点为第6个月时的死亡率(采用Kaplan-Meier法分析)、自发性细菌性腹膜炎、肝移植等。

结果:Kaplan-Meier分析显示,诺氟沙星组的6个月死亡率为14.8%,安慰剂组为19.7%(P=0.21)。考虑肝移植的竞争风险分析显示,诺氟沙星组的6个月累积死亡率显着低于安慰剂组(SHR:0.59,95%CI:0.35~0.99)。

诺氟沙星组对比安慰剂组的第6个月病死SHR,在腹水蛋白浓度<15 g/L者为0.35(95%CI:0.13~0.93),腹水蛋白浓度≥15 g/L者为1.39(95%CI:0.42~4.57)。诺氟沙星显着降低了感染发生率(包括革兰阴性菌感染),且未增加由艰难梭菌或多重耐药细菌引起的感染。

原始出处:Moreau R, Elkrief L, Bureau C, et al. Effects of Long-term Norfloxacin Therapy in Patients with Advanced Cirrhosis. Gastroenterology. 2018 Aug 22.

 

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createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Tue Feb 04 15:01:00 CST 2020, time=2020-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2010162, encodeId=97df20101628a, content=<a href='/topic/show?id=3ea49698234' target=_blank style='color:#2F92EE;'>#长期使用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96982, encryptionId=3ea49698234, topicName=长期使用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=365d170, createdName=chenwq08, createdTime=Sat Jan 04 09:01:00 CST 2020, time=2020-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1753986, encodeId=9b4d1e5398647, content=<a href='/topic/show?id=6af380418c5' target=_blank style='color:#2F92EE;'>#耐药菌感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80418, encryptionId=6af380418c5, topicName=耐药菌感染)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3f2436624042, createdName=hxq78328, createdTime=Tue Aug 27 05:01:00 CST 2019, time=2019-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2072472, encodeId=2f7a20e24725e, content=<a href='/topic/show?id=9d4ee84647' target=_blank style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7846, encryptionId=9d4ee84647, topicName=GAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2dd327, createdName=许安, createdTime=Tue Aug 20 10:01:00 CST 2019, time=2019-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418682, encodeId=66bb141868208, content=<a href='/topic/show?id=b07e8041efb' target=_blank style='color:#2F92EE;'>#耐药菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80417, encryptionId=b07e8041efb, topicName=耐药菌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=10723392161, createdName=xiaoshitou, createdTime=Thu Feb 28 17:01:00 CST 2019, time=2019-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1504609, encodeId=e4aa150460944, content=<a href='/topic/show?id=7730e85412' target=_blank style='color:#2F92EE;'>#Gastroenterology#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7854, encryptionId=7730e85412, topicName=Gastroenterology)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5fc29706655, createdName=chaojitidian, createdTime=Thu Feb 28 17:01:00 CST 2019, time=2019-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522642, encodeId=c60d152264276, content=<a href='/topic/show?id=e4084348856' target=_blank style='color:#2F92EE;'>#多重耐药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43488, encryptionId=e4084348856, topicName=多重耐药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=476711462137, createdName=gao_jian4221, createdTime=Thu Feb 28 17:01:00 CST 2019, time=2019-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1601078, encodeId=75e816010e89d, content=<a href='/topic/show?id=a524434943e' target=_blank style='color:#2F92EE;'>#多重耐药菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43494, encryptionId=a524434943e, topicName=多重耐药菌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=646d18833414, createdName=lanyan20020092, createdTime=Thu Feb 28 17:01:00 CST 2019, time=2019-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1604562, encodeId=74b61604562e6, content=<a href='/topic/show?id=2a959193334' target=_blank style='color:#2F92EE;'>#诺氟沙星#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91933, encryptionId=2a959193334, topicName=诺氟沙星)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f75719226432, createdName=wsusan1972, createdTime=Thu Feb 28 17:01:00 CST 2019, time=2019-02-28, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=2064640, encodeId=02cc2064640e0, content=<a href='/topic/show?id=94ffe853a7' target=_blank style='color:#2F92EE;'>#Gastroenterol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7853, encryptionId=94ffe853a7, topicName=Gastroenterol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0bed488, createdName=jktdtl, createdTime=Thu Sep 26 06:01:00 CST 2019, time=2019-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1711844, encodeId=48671e11844d9, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Tue Feb 04 15:01:00 CST 2020, time=2020-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2010162, encodeId=97df20101628a, content=<a href='/topic/show?id=3ea49698234' target=_blank style='color:#2F92EE;'>#长期使用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96982, encryptionId=3ea49698234, topicName=长期使用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=365d170, createdName=chenwq08, createdTime=Sat Jan 04 09:01:00 CST 2020, time=2020-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1753986, encodeId=9b4d1e5398647, content=<a href='/topic/show?id=6af380418c5' target=_blank style='color:#2F92EE;'>#耐药菌感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, 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objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80417, encryptionId=b07e8041efb, topicName=耐药菌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=10723392161, createdName=xiaoshitou, createdTime=Thu Feb 28 17:01:00 CST 2019, time=2019-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1504609, encodeId=e4aa150460944, content=<a href='/topic/show?id=7730e85412' target=_blank style='color:#2F92EE;'>#Gastroenterology#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7854, encryptionId=7730e85412, topicName=Gastroenterology)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5fc29706655, createdName=chaojitidian, createdTime=Thu Feb 28 17:01:00 CST 2019, time=2019-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522642, encodeId=c60d152264276, content=<a href='/topic/show?id=e4084348856' target=_blank style='color:#2F92EE;'>#多重耐药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43488, encryptionId=e4084348856, topicName=多重耐药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=476711462137, createdName=gao_jian4221, createdTime=Thu Feb 28 17:01:00 CST 2019, time=2019-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1601078, encodeId=75e816010e89d, content=<a href='/topic/show?id=a524434943e' target=_blank style='color:#2F92EE;'>#多重耐药菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43494, encryptionId=a524434943e, topicName=多重耐药菌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=646d18833414, createdName=lanyan20020092, createdTime=Thu Feb 28 17:01:00 CST 2019, time=2019-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1604562, encodeId=74b61604562e6, content=<a href='/topic/show?id=2a959193334' target=_blank style='color:#2F92EE;'>#诺氟沙星#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91933, encryptionId=2a959193334, topicName=诺氟沙星)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f75719226432, createdName=wsusan1972, createdTime=Thu Feb 28 17:01:00 CST 2019, time=2019-02-28, status=1, ipAttribution=)]
    2019-08-20 许安
  6. [GetPortalCommentsPageByObjectIdResponse(id=2064640, encodeId=02cc2064640e0, content=<a href='/topic/show?id=94ffe853a7' target=_blank style='color:#2F92EE;'>#Gastroenterol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7853, encryptionId=94ffe853a7, topicName=Gastroenterol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0bed488, createdName=jktdtl, createdTime=Thu Sep 26 06:01:00 CST 2019, time=2019-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1711844, encodeId=48671e11844d9, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, 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  7. 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通常,我们垂涎橱窗内的美食时,会不自觉地咽口水和感觉更强烈的饥饿感。其实,这些吃货深有同感的反应并不是身体“准备迎接”食物的第一反应。近期,一项新研究揭示,在小鼠看到或者闻到食物的瞬间,其大脑神经和肝脏都做出了“处理营养”的准备。

肝脏局灶型巨淋巴结增生症的18F-FDG PET/CT表现1例

患者女,63岁。因体检超声发现肝占位1月余入院。患者无发热、恶心、呕吐、腹部疼痛及后背放射痛。既往有结核病史,已治愈;8年前因子宫息肉接受子宫切除术。实验室检查:淋巴细胞比例升高(0.401),白细胞计数增高(107.7×109/L),乙型病毒性肝炎阴性,肿瘤标志物血清癌胚抗原、甲胎蛋白及CA19-9均正常。