Md Nazmul Haque, Mamun Al-Mahtab, Dulal C Das, Noor-E-Alam Sheikh Mohammad, Ayub A Mamun, Md Sakirul I Khan, Sheikh Mf Akbar, Salimur Rahman
{"title":"Effect of Granulocyte Colony-stimulating Factor and Erythropoietin on Patients with Acute-on-chronic Liver Failure.","authors":"Md Nazmul Haque, Mamun Al-Mahtab, Dulal C Das, Noor-E-Alam Sheikh Mohammad, Ayub A Mamun, Md Sakirul I Khan, Sheikh Mf Akbar, Salimur Rahman","doi":"10.5005/jp-journals-10018-1330","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Patients with acute-on-chronic liver failure (ACLF) have low survival without liver transplantation. Granulocyte colony-stimulating factor (G-CSF) improves survival in ACLF and erythropoietin (EPO) promotes hepatic regeneration in animal studies. The aim of this study is to determine whether coadministration of G-CSF and EPO improves the outcome in ACLF.</p><p><strong>Methods: </strong>The study was conducted in the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka. Consecutive patients with ACLF were randomly assigned into group A and group B. Group A patients received subcutaneous G-CSF (5 mcg/kg/d) for 6 days and subcutaneous EPO (40 mcg/wk) for 4 weeks and group B patients received only standard medical care (control group). All patients were followed up for 3 months. The primary end point was to see survival at 3 months.</p><p><strong>Results: </strong>Patients had comparable baseline characteristics; hepatitis B virus infection was the commonest etiology of ACLF as both acute and chronic events. A higher proportion of patients were male in both groups. The survival was higher in group A than in group B at the end of 3 months (36.4% vs 29.4%; <i>p</i> = 0.457), but this was not statistically significant. Regarding complications, hepatorenal syndrome was higher in group B than in group A (36.7% vs 41.7%). In both the groups, Child-Turcotte-Pugh score and model for end-stage liver disease scores were similar before treatment and improved during follow-up.</p><p><strong>Conclusion: </strong>This is one of the early human studies that demonstrate potential hepatic regeneration using EPO in ACLF patients. Further study with a larger cohort will be needed to reproduce the results of the present work.</p><p><strong>How to cite this article: </strong>Haque Md N, Al-Mahtab M, Das DC, <i>et al</i>. Effect of Granulocyte Colony-stimulating Factor and Erythropoietin on Patients with Acute-on-chronic Liver Failure. Euroasian J Hepato-Gastroenterol 2020;10(2):64-67.</p>","PeriodicalId":11992,"journal":{"name":"Euroasian Journal of Hepato-Gastroenterology","volume":"10 2","pages":"64-67"},"PeriodicalIF":0.0000,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/16/ca/ejohg-10-64.PMC7801888.pdf","citationCount":"6","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Euroasian Journal of Hepato-Gastroenterology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5005/jp-journals-10018-1330","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 6
Abstract
Introduction: Patients with acute-on-chronic liver failure (ACLF) have low survival without liver transplantation. Granulocyte colony-stimulating factor (G-CSF) improves survival in ACLF and erythropoietin (EPO) promotes hepatic regeneration in animal studies. The aim of this study is to determine whether coadministration of G-CSF and EPO improves the outcome in ACLF.
Methods: The study was conducted in the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka. Consecutive patients with ACLF were randomly assigned into group A and group B. Group A patients received subcutaneous G-CSF (5 mcg/kg/d) for 6 days and subcutaneous EPO (40 mcg/wk) for 4 weeks and group B patients received only standard medical care (control group). All patients were followed up for 3 months. The primary end point was to see survival at 3 months.
Results: Patients had comparable baseline characteristics; hepatitis B virus infection was the commonest etiology of ACLF as both acute and chronic events. A higher proportion of patients were male in both groups. The survival was higher in group A than in group B at the end of 3 months (36.4% vs 29.4%; p = 0.457), but this was not statistically significant. Regarding complications, hepatorenal syndrome was higher in group B than in group A (36.7% vs 41.7%). In both the groups, Child-Turcotte-Pugh score and model for end-stage liver disease scores were similar before treatment and improved during follow-up.
Conclusion: This is one of the early human studies that demonstrate potential hepatic regeneration using EPO in ACLF patients. Further study with a larger cohort will be needed to reproduce the results of the present work.
How to cite this article: Haque Md N, Al-Mahtab M, Das DC, et al. Effect of Granulocyte Colony-stimulating Factor and Erythropoietin on Patients with Acute-on-chronic Liver Failure. Euroasian J Hepato-Gastroenterol 2020;10(2):64-67.
急性伴慢性肝衰竭(ACLF)患者不进行肝移植的生存率很低。在动物实验中，粒细胞集落刺激因子(G-CSF)提高ACLF患者的存活率，促红细胞生成素(EPO)促进肝脏再生。本研究的目的是确定G-CSF和EPO的联合使用是否能改善ACLF的预后。方法:本研究在达卡Bangabandhu Sheikh Mujib医科大学肝脏内科进行。连续ACLF患者随机分为A组和B组。A组患者接受G-CSF (5 mcg/kg/d)皮下注射6天，EPO (40 mcg/周)皮下注射4周，B组患者仅接受标准医疗护理(对照组)。所有患者均随访3个月。主要终点是观察3个月的生存率。结果:患者具有可比的基线特征;乙型肝炎病毒感染是ACLF最常见的病因，无论是急性还是慢性事件。两组患者中男性比例均较高。3个月末，A组生存率高于B组(36.4% vs 29.4%;P = 0.457)，但差异无统计学意义。在并发症方面，B组肝肾综合征发生率高于A组(36.7% vs 41.7%)。在两组中，child - turcote - pugh评分和终末期肝病模型评分在治疗前相似，并在随访期间有所改善。结论:这是早期的人类研究之一，证明了促生成素在ACLF患者中的肝再生潜力。需要对更大的队列进行进一步的研究，以重现目前工作的结果。本文引用方式:Haque Md N, al - mahtab M, Das DC等。粒细胞集落刺激因子和促红细胞生成素对急慢性肝衰竭患者的影响。中华肝病与胃肠病杂志;2020;10(2):64-67。
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
