奥沙利铂相关门静脉高压的临床特征和内镜治疗效果  

Clinical characteristics and efficacy of endoscopic treatment in oxaliplatin-associated portal hypertension

作　　者：倪礼爰 黄晓铨 姜思雨 艾英杰 吴玲 陈世耀 Ni Liyuan;Huang Xiaoquan;Jiang Siyu;Ai Yingjie;Wu Ling;Chen Shiyao(Department of Gastroenterology and Hepatology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Center of Evidence-based Medicine,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 [2]复旦大学附属中山医院消化科复旦大学循证医学中心,上海20003

出　　处：《中华消化杂志》2024年第11期744-750,共7页Chinese Journal of Digestion

基　　金：国家重点研发计划(2023YFC2507500)。

摘　　要：目的:建立奥沙利铂相关门静脉高压患者队列,通过与乙型肝炎、血吸虫相关肝硬化门静脉高压患者对比,了解此类患者的病程特征、疾病特点和内镜治疗的预后。方法:选择2014年1月1日至2021年12月31日于复旦大学附属中山医院经奥沙利铂化学治疗后诊断为门静脉高压食管胃静脉曲张的患者(以下简称奥沙利铂总队列组)。奥沙利铂总队列组中因食管胃静脉曲张出血首次接受内镜治疗的患者作为奥沙利铂组。另选择2014年1月1日至2016年12月31日复旦大学附属中山医院因乙型肝炎或血吸虫相关门静脉高压食管胃静脉曲张出血首次接受内镜治疗的患者(以下分别简称乙肝组和血吸虫组)。收集患者的既往肿瘤、化学治疗病史,入院后实验室、影像学、病理检查结果,分析临床特征。收集各组患者临床资料并随访比较奥沙利铂组、乙肝组和血吸虫组3组患者的临床特征,以及内镜治疗后的3年累积无出血率和3年累积生存率。绘制Kaplan-Meier生存曲线评估治疗效应,采用log-rank法比较生存曲线差异。采用卡方检验和Mann-Whitney U检验进行统计学分析。结果:奥沙利铂总队列组患者93例,中位化学治疗疗程(范围)为8(6~10)个周期,从化学治疗结束至确诊食管胃静脉曲张的中位时间(范围)为4(2~6)年,奥沙利铂组患者55例,乙肝组和血吸虫组患者分别为191、96例。奥沙利铂总队列组中78.5%(73/93)的患者为Child-Pugh A级,33例(35.5%)患者存在门静脉系统血栓。患者腹部影像学显示无明显肝脏缩小、表面凹凸不平等肝硬化表现。奥沙利铂总队列组11例患者肝穿刺病理主要表现为肝汇管区血管损伤、纤维沉积,伴有淋巴细胞浸润,肝细胞损伤轻微,无假小叶形成。基线特征方面,奥沙利铂组患者直接胆红素、丙氨酸转氨酶、天冬氨酸转氨酶水平均低于乙肝组和血吸虫组[4.8(3.9,6.5)μmol/L比6.4(4.7,9.0)和6.5(4.4,Objective:A cohort of patients with oxaliplatin-associated portal hypertension was established and compared with patients with hepatitis B or schistosomiasis-associated cirrhotic portal hypertension to explore the course,disease features and prognosis of endoscopic treatment.Methods:From January 1,2014 to December 31,2021,patients diagnosed with portal hypertension and gastroesophageal varices after oxaliplatin chemotherapy at Zhongshan Hospital of Fudan University were selected(oxaliplatin general group).The patients who received endoscopic treatment for the first time because of esophagogastric variceal bleeding in the oxaliplatin general group were included in the oxaliplatin group.From January 1,2014 to December 31,2016,patients who initially received endoscopic treatment for the first time because of esophagogastric variceal bleeding due to hepatitis B or schistosomiasis-associated cirrhotic portal hypertension at Zhongshan Hospital of Fudan University were enrolled(hepatitis B group and schistosomiasis group).The history of oncology and chemotherapy,laboratory results,imaging and pathological findings were collected,and the clinical features were analyzed.Clinical data were collected,and the clinical features,3-year cumulative non-bleeding rate and survival rate after endoscopic treatment of the 3 groups including oxaliplatin group,hepatitis B group and schistosomiasis group were compared.Kaplan-Meier survival curve was drawn to estimate treatment effects,and log-rank method was performed to test the differences in survival curves.Chi-square test and Mann-Whitney U test were used for statistical analysis.Results:There were 93 patients in oxaliplatin general group,with a median chemotherapy course of 8(ranged from 6 to 10)cycles,and the median time from the end of chemotherapy to the diagnosis of gastroesophageal varices was 4(ranged from 2 to 6)years.There were 55 patients in oxaliplatin group,191 cases in hepatitis B group and 96 cases in schistosomiasis group.There were 78.5%(73/93)of patients in the oxal

关 键 词：门静脉高压 食管胃静脉曲张出血 奥沙利铂 内镜治疗 

分 类 号：R575.2[医药卫生—消化系统]