三种不同方法预防肝硬化食管静脉曲张首次出血的疗效及安全性评价  

Efficacy and safety of three different methods for primary prophylaxis of variceal bleeding in cirrhosis

作　　者：刘信[1] 李敏[1] 

机构地区：[1]安徽医科大学附属安庆医院消化内科,安徽省安庆市246003

出　　处：《世界华人消化杂志》2014年第2期253-258,共6页World Chinese Journal of Digestology

摘　　要：目的:比较内镜下食管曲张静脉套扎术(endoscopic variceal ligation,EVL)、非选择性β受体阻滞剂普萘洛尔及两者联合应用预防肝硬化食管静脉曲张首次出血的疗效及其安全性.方法:选取食管静脉曲张有出血高危因素的肝硬化患者90例,随机分成EVL组(n=30)、药物组(n=30)和联合组(n=30),分别接受EVL、普萘洛尔及EVL+普萘洛尔治疗,观察各组患者的疗效及不良反应发生情况.结果:3组患者治疗前各指标具有可比性;平均随访时间3组无明显差异分别为19.9 mo±7.2 mo、19.3 mo±6.7 mo、21.4 mo±5.3mo(P=0.832);EVL平均套扎2.2次±1.2次,联合组平均套扎2.0次±0.9次(P>0.05);药物组普萘洛尔平均剂量75.6 mg±23.4 mg,联合组平均剂量68.8 mg±30.5 mg(P>0.05);3组首次静脉曲张出血率及出血相关死亡率无明显差异(10.0%,16.7%vs 6.6%,P=0.455);门脉高压性胃病发生率3组无显著差异(16.7%,6.6%vs 10.0%,P>0.05);并发症及不良反应发生率差异有统计学意义(50.0%,26.7%vs 56.7%,P<0.05),均未见明显严重并发症及不良反应;静脉曲张复发率(EVL组26.7%vs联合组6.6%,P=0.04),两者差异有显著性.结论:EVL、普萘洛尔及两者联合预防食管中-重度静脉曲张首次出血均有效、安全,但普洛萘尔引起的不良反应最少;EVL联合普萘洛尔在静脉曲张复发率低于单纯EVL,且不良反应不增多,但需要更大的样本量和长期的跟踪随访来进一步证实.AIM： To compare the efficacy and safety of endoscopic variceal ligation （EVL）, propranolol and EVL plus propranolol for the primary prophylaxis of first variceal bleeding in cirrhosis. METHODS： We chose 90 patients with cirrhosis and esophageal varices at a high risk of bleeding and divided them into EVL （n = 30）, propranolol （n = 30） and combination （n = 30） groups. Treatment effectiveness and side effects in the 3 groups were compared. RESULTS： The three groups of patients had comparable baseline characteristics and follow-up time （EVL： 19.9 mo ± 7.2 mo; propranolol： 19.3 mo ± 6.7 mo; combination： 21.4 mo ± 5.3 mo）. There were no significant differences in average ligation times between the EVL group and combination group （2.2 ± 1.2 vs 2.0 ± 0.9, P 〉 0.05）, mean daily propranolol dose between the propranolol group and combination group（75.6 mg ± 23.4 mg vs 68.8 mg ± 30.5 mg, P 〉 0.05）, rate of first variceal bleeding and bleeding-related mortality （10.0%, 16.7% vs 6.6%, both P 〉 0.05） or incidence of portal hypertensive gastropathy between the three groups （16.7%, 6.6% vs 10.0%, both P 〉 0.05）. The incidence of complications and adverse reactions was significantly different between the three groups （50.0%, 26.7% vs 56.7%, both P 〈 0.05）, but no serious complications or adverse reactions occurred. The difference in variceal recurrence rate was significant between the EVL group and combination group （26.7% vs 6.6%, P = 0.04）. CONCLUSION： EVL, propranolol and EVL plus propranolol are effective and safe in primary prophylaxis of bleeding due to high-risk varices. The adverse effects caused by propranolol are minimal. The recurrence of varices is lower if propranolol is added to EVL, but without much more adverse reactions.

关 键 词：肝硬化 普萘洛尔 一级预防 食管静脉曲张 食管曲张静脉套扎术 食管曲张静脉出血 

分 类 号：R575.2[医药卫生—消化系统]