丙型肝炎持续病毒应答与肝硬化食管胃静脉曲张患者内镜治疗后再出血的相关性  

The relationship between sustained virological response and re-bleeding risk of chronic hepatitis C patients after endoscopic management of gastroesophageal varices

作　　者：黄晓铨 吴玲 姜思雨 李锋 陈世耀 HUANG Xiao-quan;WU Ling;JIANG Si-yu;LI Feng;CHEN Shi-yao(Department of Gastroenterology and Hepatology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院消化科,上海200032

出　　处：《肝脏》2021年第6期597-601,共5页Chinese Hepatology

基　　金：中国肝炎防治基金会王宝恩肝纤维化研究基金(2019045)。

摘　　要：目的探究丙型肝炎患者是否获得持续病毒应答(SVR)对内镜治疗食管胃静脉曲张破裂出血疗效的影响。方法纳入2013年1月至2019年12月复旦大学附属中山医院丙肝肝硬化食管胃静脉曲张破裂出血患者49例,根据其首次接受内镜下食管静脉曲张套扎联合胃组织胶治疗时HCV RNA是否阳性,分为SVR组和nSVR组,随访患者内镜治疗后再出血、肝硬化相关并发症及生存情况。结果49例患者中,26例SVR组患者与23例nSVR组患者内镜治疗后1年、2年和3年的累积无出血率分别为78.4%比73.9%,58.9%比63.4%,58.9%比43.4%(P=0.478);两组患者内镜治疗后的3年累积生存差异无统计学意义(P=0.667)。食管套扎联合胃组织胶治疗是降低再出血的独立保护因素(HR 0.21,95%CI:0.08~0.53,P=0.001)。结论丙肝患者是否获得SVR不影响内镜治疗食管胃静脉曲张破裂出血的疗效,内镜下食管静脉曲张套扎联合胃静脉曲张组织胶治疗是最佳选择。Objective To investigate the impact of sustained virological response(SVR)on the re-bleeding risk of chronic hepatitis C patients after endoscopic management of gastroesophageal varices bleeding(GVB).Methods A total of 49 patients admitted to Zhongshan Hospital,Fudan University with HCV related GVB were included in this study.They were divided into SVR group(N=26 patients)and non-SVR group(N=23 patients)according to their serum HCV RNA levels detected at the time of primary endoscopic therapy for GVB by esophageal variceal ligation(EVL)combined with histoacryl injection(HI).The occurances of re-bleeding and other complications of cirrhosis,and the survival rates of these patients in three years after endoscopic treatment were follow-up.Results Kaplan-Meier survival analysis showed that there were no significant differences in the cumulative rebleeding-free rates at 1-year,2-year and 3-year between the SVR group and the non-SVR group,the same went for the cumulative survival rates between these two groups.The results of Multivariate analysis showed that the clearance of HCV did not influence the efficacy of endoscopic management of HCV-related GVB.The endoscopic treatment of EVL plus HI is an independent protective factor against re-bleeding in HCV-related cirrhotic patients with GVB.Conclusion The clearance of HCV RNA did not influence the efficacy of endoscopic management of HCV-related GVB.EVL plus HI can be the optimal treatment selection in these patients.

关 键 词：丙型肝炎 持续病毒应答 食管胃静脉曲张静脉曲张 内镜治疗 再出血 

分 类 号：R575.2[医药卫生—消化系统] R512.63[医药卫生—内科学]