特利加压素联合生长抑素治疗肝硬化并发上消化道出血患者疗效研究

doi:10.3969/j.issn.1672-5069.2020.06.025

摘要/Abstract

摘要： 目的研究应用特利加压素联合生长抑素治疗肝硬化并发上消化道出血患者的疗效及其血清胰高血糖素(GCG)和一氧化氮(NO)水平的变化。方法 2018年5月~2019年7月我院消化内科收治的104例乙型肝炎肝硬化并发上消化道出血患者,被随机分为对照组52例和观察组52例,分别给予生长抑素或生长抑素联合特利加压素治疗,两组均治疗3 d。采用免疫散射比浊法检测血清高敏C反应蛋白(hs-CRP),采用化学发光法检测血清皮质醇(COR),采用化学发光免疫分析法检测血清GCG和采用间接比色法检测血清NO水平。结果观察组呕血停止、血压平稳和止血时间分别为(5.2±2.1)h、(11.9±3.1)h和(21.9±7.1)h,显著短于对照组【分别为(8.5±2.3)h、(15.5±5.3)h和(30.5±5.3)h, P<0.05】,观察组出血控制率为94.2%,显著高于对照组的78.9%(P<0.05)。观察组死亡3例(5.8%),对照组死亡11例(21.2%,P<0.05);治疗后,观察组外周血血红蛋白水平为(107.3±19.4)g/L,显著高于对照组【(98.6±17.9)g/L,P<0.05】,血细胞比容为(37.6±5.8)%,显著高于对照组【(29.4±6.5)%,P<0.05】,血小板计数为(101.4±19.2)×10⁹/L,显著高于对照组【(92.8±18.4)×10⁹/L,P<0.05】;观察组门静脉血流为(481.3±91.7)mL/min,显著慢于对照组【(608.6±98.5)mL/min,P<0.05】,脾静脉血流为(231.4±44.2)mL/min,显著低于对照组【(302.8±52.4)mL/min,P<0.05】,门静脉内径为(12.6±1.1)mm,显著低于对照组【(14.7±1.0)mm,P<0.05】,脾静脉内径为(9.2±0.8)mm,低于对照组【(12.6±0.9)mm,P<0.05】;血清hs-CRP水平为(6.5±1.1)μg/L,显著低于对照组【(12.3±3.2)μg/L,P<0.05】,血清COR水平为(281.2±12.6)μg/L,显著低于对照组【(318.7±14.9)g/L,P<0.05】,血清GCG水平为(149.8±17.4)ng/L,显著低于对照组【(182.4±19.3)ng/L,P<0.05】,而血清NO水平为(119.4±10.7)μmol/L,显著高于对照组【(96.9±12.6)μmol/L,P<0.05】。结论特利加压素联合生长抑素治疗肝硬化并发上消化道出血患者止血效果好,可能与稳定了血液循环功能,降低了血清应激指标有关。

关键词: 肝硬化, 上消化道出血, 特利加压素, 生长抑素, 胰高血糖素, 一氧化氮, 治疗

Abstract: Objective The purpose of this study was to investigate the efficacy of terlipressin and somatostatin combination in the treatment of cirrhotic patients with upper gastrointestinal bleeding, and serum glucagon (GCG) and nitric oxide (NO) level changes. Methods 104 hepatitis B cirrhotic patients with upper gastrointestinal bleeding were enrolled in our hospital and were randomly divided into observation (n=52) and control group (n=52). The patients in the control group were treated with somatostatin, and those in the observation group were treated with terlipressin based on somatostatin. The regimen lasted for3 days. Serum high-sensitivity C-reactive protein (hs-CRP), cortisol (COR), glucagon (GCG) and nitric oxide (NO) were assayed. Results The stopping time of hematemesis, stable blood pressure and hemostatic time in the combination group were (5.2±2.1)h, (11.9±3.1)h and (21.9±7.1)h, significantly shorter than 【(8.5±2.3)h, (15.5±5.3)h and (30.5±5.3)h, respectively, P<0.05】 in the control, and the the effective rate in the former was 94.2%, much higher than 78.9%(P<0.05) in the latter; after treatment, the blood hemoglobin was (107.3±19.4) g/L, much higher than [(98.6±17.9) g/L, P<0.05], the hematocrit was (37.6±5.8)%, much higher than【(29.4±6.5)%, P<0.05】 and platelet counts was (101.4±19.2)×10⁹/L, significantly higher than 【(92.8±18.4)×10⁹/L, P<0.05】 in the control; the portal vein blood flow was (481.3±91.7) mL/min, much slower than [(608.6±98.5) mL/min, P<0.05], the splenic vein blood flow was (231.4±44.2) mL/min, much slower than [(302.8±52.4) mL/min, P<0.05], the diameter of portal vein was(12.6±1.1)mm, significantly lower than 【(14.7±1.0)mm, P<0.05】 and the splenic vein diameter was (9.2±0.8)mm, much lower than 【(12.6±0.9)mm, P<0.05】 in the control; serum hs-CRP level was (6.5±1.1) μg/L, much lower than 【(12.3±3.2)μg/L, P<0.05】, serum COR level was (281.2±12.6)μg/L, much lower than 【(318.7±14.9)g/L, P<0.05】 and serum GCG level was (149.8±17.4)ng/L, much lower than 【(182.4±19.3)ng/L, P<0.05】, while serum NO level was (119.4±10.7)μmol/L, significantly higher than 【(96.9±12.6)μmol/L, P<0.05】 in the control. Conclusion The successful hemostasis is obtained by administration of terlipressin and somatostatin combination in cirrhotic patients with variceal hemorrhage, which might reduce blood GCG and elevate NO levels.

Key words: Liver cirrhosis, Variceal hemorrhage, Terlipressin, Somatostatin, Glucagon, Nitric oxide, Therapy

刘慧, 张诒凤, 郁磊. 特利加压素联合生长抑素治疗肝硬化并发上消化道出血患者疗效研究[J]. 实用肝脏病杂志, 2020, 23(6): 857-860.

Liu Hui, Zhang Yifeng, Yu Lei. Application of terlipressin and somatostatincombination in treatment of cirrhotic patients with upper gastrointestinal bleeding[J]. Journal of Practical Hepatology, 2020, 23(6): 857-860.

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