抗肝纤维化治疗对肝硬化食管胃静脉曲张出血的一级预防作用  

Primary preventive effect of anti-fibrosis treatment on esophageal and gastric varices bleeding in patients with cirrhosis:a real-world study

作　　者：牛帅帅 张群 侯艺鑫 王宪波 NIU Shuai-shuai;ZHANG Qun;HOU Yi-xin;WANG Xian-bo(Department of Integrated Chinese and Western Medicine,Beijing Ditan Hospital,Capital Medical University,Beijing 10015,China)

机构地区：[1]首都医科大学附属北京地坛医院中西医结合中心

出　　处：《中西医结合肝病杂志》2019年第4期305-309,共5页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：首都卫生发展科研专项(No.2018-1-2172);北京市医院管理局临床医学发展专项经费资助(No.ZYLX201707)

摘　　要：目的:探讨抗肝纤维化治疗对肝硬化食管胃静脉曲张破裂出血(EVB)的一级预防作用。方法:收集首都医科大学附属北京地坛医院2008年8月至2017年8月住院诊断为肝硬化食管胃静脉曲张患者999例,通过COX回归分析影响EVB的独立影响因素;根据患者应用抗纤维化中药治疗是否≥30 d分为中药组和对照组,按照倾向性评分的方法对两组患者进行1∶1匹配,中药组和对照组各441例,采用Kalplan-Merier法比较两组患者累积出血率。结果:抗肝纤维化治疗是预防肝硬化食管胃静脉曲张患者1年内出血独立保护因素(P<0.05),中药组患者1年内出血率低于对照组(5.2%vs9.7%,P=0.001)。对病情严重程度和病因分别进行分层分析,发现出血风险显著下降的是Child-Pugh评分为C级患者(2.7%vs12.1%,P=0.03)和酒精性肝硬化患者(6.1%vs19.1%)。结论:抗肝纤维化治疗可以降低肝硬化EVB患者1年内出血风险,具有一级预防作用;治疗的优势人群为酒精性肝硬化和Child-Pugh评分为C级的患者。Objective:To investigate the primary preventive effect of anti-fibrosis treatment on cirrhotic esophagogastric variceal hemorrhage(EVB).Methods:A total of 999 cirrhotic patients with GOV who were admitted to Beijing Ditan Hospital,Capital Medical University,from August 2008 to August 2017 were enrolled and followed up for one year.COX regression analysis was used to analyze the independent influencing factors of EVB.According to whether patients were treated with anti-fibrotic Chinese medicine,they were divided into Chinese medicine group and control group.After 1∶1 case matching between the two groups of cohorts,441 patients were obtained from each group.The bleeding rates of the two groups were compared by the Kalplan-Merier method.Results:Anti-liver fibrosis treatment was an independent protective factor for bleeding in patients with GOV within 1 year(P<0.05).The bleeding rate in the Chinese medicine group was lower than that in the control group(5.2%vs 9.7%,P=0.001).Further stratified analysis found that patients with a Child-Pugh score of grade C(2.7%vs 12.1%,P=0.03)and patients with alcoholic cirrhosis(6.1%vs 19.1%)had a significant reduction in bleeding risk.Conclusion:Anti-fibrosis treatment can reduce the risk of bleeding in patients with cirrhosis of GOV within 1 year,and has a primary prevention effect;the dominant population for treatment is alcoholic cirrhosis and Child-Pugh score of C grade.

关 键 词：肝硬化 食管胃静脉曲张出血 肝纤维化 一级预防 

分 类 号：R57[医药卫生—消化系统]