内镜结扎联合中医辨证论治对肝硬化食管静脉曲张破裂出血的二级预防效果  

Effect of endoscopic ligation combined with traditional Chinese medicine syndrome differentiation-based treatment in the secondary prevention of esophageal variceal bleeding in patients with liver cirrhosis

作　　者：陈冲 吕莹 陈茜蕾 刘成海[1] 刘平[1] 慕永平[1] CHEN Chong;LYU Ying;CHEN Xilei;LIU Chenghai;LIU Ping;MU Yongping(Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Institute of Liver Diseases,Shanghai Institute of Traditional Chinese Medicine,Key Laboratory of Liver and Kidney Diseases,Ministry of Education,Shanghai Key Laboratory of Traditional Chinese Clinical Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院,上海市中医药研究院肝病研究所,肝肾疾病病证教育部重点实验室,上海市中医临床重点实验室,上海201203

出　　处：《临床肝胆病杂志》2022年第5期1075-1080,共6页Journal of Clinical Hepatology

基　　金：国家自然科学基金(81874390);上海市科学技术委员会科技创新项目(15411950500);上海市临床重点专科建设项目(shslczdzk01201)。

摘　　要：目的观察内镜下结扎联合中医辨证论治防治肝硬化食管静脉曲张破裂出血(EVB)二级预防的疗效。方法选取2015年4月—2021年2月上海中医药大学附属曙光医院肝硬化科收治的行内镜下结扎治疗的EVB患者108例,对同时服用中药治疗的患者定义为中西医组(n=59),对未服用中药治疗的患者定义西医组(n=49)。比较两组患者的再出血发生率、病死率以及门静脉高压性胃病的改善率等。计量资料符合正态分布者采用t检验;不符合正态分布者采用Mann-Whitney U秩和检验;计数资料2组间对比采用χ^(2)检验或Fisher确切概率法;并采用Cox回归分析评估影响再出血的危险因素。结果中西医组内镜结扎后13~24个月的再出血率显著低于西医组(2%vs 12%,P=0.045);中西医组再出血病死率显著低于西医组(2%vs 12%,P=0.045),且门静脉高压性胃病的总有效率显著高于西医组(90%vs 77%,P=0.04)。基础疾病(主要包括糖尿病、高血压、心脏病)及肝功能Child-Pugh分级是影响再出血的显著危险因素(P值均<0.05)。结论内镜结扎联合中医辨证论治可显著降低EVB的迟发性再出血发生率和病死率,改善门静脉高压性胃病的程度,为结扎联合中医药提高EVB二级预防的综合疗效提供了新策略。Objective To investigate the efficacy of endoscopic ligation combined with traditional Chinese medicine(TCM)syndrome differentiation-based treatment in the secondary prevention of esophageal variceal bleeding(EVB)in patients with liver cirrhosis.MethodsA total of 108 EVB patients who were admitted to Department of Liver Cirrhosis,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from April 2015 to February 2021 and underwent endoscopic ligation were enrolled,among whom 59 patients with TCM treatment were enrolled as Chinese and Western medicine group,and 49 patients without TCM treatment were enrolled as Western medicine group.The two groups were compared in terms of the incidence rate of rebleeding,mortality rate,and the improvement rate of portal hypertensive gastropathy.The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between groups;the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups;a Cox regression analysis was used to evaluate the risk factors for rebleeding.Results Compared with the Western medicine group,the Chinese and Western medicine group had a significantly lower rebleeding rate within 13-24 months after ligation(2%vs 12%,P=0.045),a significantly lower mortality rate of rebleeding(2%vs 12%,P=0.045),and a significantly higher overall response rate of portal hypertensive gastropathy(90%vs 77%,P=0.04).Underlying diseases(mainly including diabetes,hypertension,and heart disease)and Child-Pugh class for liver function were significant risk factors for rebleeding(all P<0.05).Conclusion Ligation combined with TCM treatment can significantly reduce the incidence rate of delayed rebleeding and the mortality rate of EVB and improve the degree of portal hypertensive gastropathy,which provides a new strategy for ligation combined with TCM treatment to improve the overall respo

关 键 词：肝硬化 食管和胃静脉曲张 内窥镜检查 医学 中国传统 

分 类 号：R57[医药卫生—消化系统]