内镜下套扎术联合奥美拉唑和奥曲肽治疗肝硬化并发食管静脉曲张首次出血患者短期疗效分析*

doi:10.3969/j.issn.1672-5069.2022.06.027

摘要/Abstract

摘要： 目的总结采用内镜下曲张静脉套扎术(EVL)联合奥美拉唑和奥曲肽治疗肝硬化并发食管静脉曲张出血(EVB)患者的短期止血效果。方法 2018年1月～2021年1月我院收治的60例肝硬化并发EVB患者,其中30例对照组应用奥美拉唑和奥曲肽治疗,另30例观察组在对照组治疗的基础上联合EVL治疗。使用彩色多普勒超声诊断仪检测门静脉和脾静脉血管内径、血流速度和血流量,采用ELISA法检测血清胃泌素(GAS)和胰高血糖素(GLC)水平,采用放射免疫法检测血清Ⅲ型前胶原氨基末端肽(PIIINP)水平。结果在治疗后1 w,观察组总有效率为96.7%,显著高于对照组的76.8%(P<0.05);观察组急诊止血率为93.3%,显著高于对照组的73.3%(P<0.05),早期和迟发再出血发生率率分别为10.0%和3.3%,均显著低于对照组(33.3%和20.0%,P<0.05);观察组门静脉平均血流速度和血流量分别为(14.2±2.3)cm/s和(1224.6±173.2)mL/min,均显著大于对照组【分别为(12.1±1.6)cm/s和(1030.7±164.5)mL/min,P<0.05】,脾静脉平均血流速度和血流量分别为(14.4±1.9)cm/s和(934.6±185.3)mL/min,均显著大于对照组【(12.3±1.7)cm/s和(731.3±172.4)mL/min,P<0.05】;观察组血清PIIINP、GAS和GLC水平分别为(173.6±19.5)μg/L、(69.7±9.6)ng/L和(52.3±7.1)ng/L,均显著低于对照组【分别为(202.8±23.1)μg/L、(91.4±12.3)ng/L和(62.4±8.3)ng/L,P<0.05】;在EVL术后发生咽部不适6例,胸骨后疼痛6例,吞咽困难1例,腹胀腹痛2例,恶心呕吐1例,并发症发生率为53.3%。结论采用EVL联合奥美拉唑和奥曲肽治疗肝硬化并发EVB患者具有较好的短期止血效果,且改善了门静脉和脾静脉血流动力学指标,具有一定的安全性。

关键词: 肝硬化, 食管静脉曲张, 内镜下曲张静脉套扎术, 奥美拉唑, 奥曲肽, 治疗

Abstract: Objective The aim of this study was to investigate the short-term hemostatic effect of endoscopic variceal ligation (EVL) and omeprazole and octreotide combination in the treatment of cirrhotics with first esophageal varices bleeding (EVB). Methods 60 patients with cirrhosis and EVB were enrolled in this study between January 2018 and January 2021, and 30 patients in the control were treated with omeprazole and octreotide, while another 30 patients in the observation group were treated with EVL on the basis of medicines in the control group. The diameters, mean flow velocities and blood flows of portal vein and splenic vein were detected by color Doppler ultrasound. Serum gastrin (GAS) and glucagon (GLC) levels were detected by ELISA, and serum procollagen type III N-terminal peptide (PIIINP) level was detected by radioimmunoassay. Results 1 week after treatment, the total efficient rate in the observation group was significantly higher than that in the control group (96.7% vs. 76.8%, P<0.05), and the emergent hemostasis rate in the observation group was also higher than that in the control group (93.3% vs. 73.3%, P<0.05); the early re-bleeding rate and the delayed re-bleeding rate in the observation group were 10.0% and 3.3%, both significantly lower than 33.3% and 20.0% (P<0.05) in the control; the mean flow velocity and blood flow of portal vein in the observation group were (14.2±2.3) cm/s and (1224.6±173.2) mL/min, significantly higher than [(12.1±1.6) cm/s and (1030.7±164.5) mL/min, P<0.05], the mean flow velocity and blood flow of splenic vein in the observation group were (14.4±1.9)cm/s and (934.6±185.3)mL/min, both significantly higher than [(12.3±1.7)cm/s and (731.3±172.4)mL/min, respectively, P<0.05] in the control; serum PIIINP, GAS and GLC levels in the observation group were (173.6±19.5) μg/L, (69.7±9.6) ng/L and (52.3±7.1) ng/L, significantly lower than [(202.8±23.1) μg/L, (91.4±12.3) ng/L and (62.4±8.3) ng/L, respectively, P<0.05] in the control group; the total incidence of post-EVL complications, such as sore throat, retrosternal pain, dysphagia, abdominal distension, nausea and vomiting was 53.3%. Conclusion The short-term clinical hemostatic effect of EVL at base of omeprazole and octreotide combination is good in patients with liver cirrhosis and first EVB, which could improve hemodynamic states of portal system, with a relative safety.

Key words: Liver cirrhosis, Esophageal varices bleeding, Endoscopic variceal ligation, Omeprazole, Octreotide, Hemostasis

詹致远, 申洋, 王凡冰. 内镜下套扎术联合奥美拉唑和奥曲肽治疗肝硬化并发食管静脉曲张首次出血患者短期疗效分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 865-868.

Zhan Zhiyuan, Shen Yang, Wang Fanbing. Short-term hemostatic effect of endoscopic variceal ligation and omeprazole and octreotide combination in the treatment of cirrhotics with first esophageal varices bleeding[J]. Journal of Practical Hepatology, 2022, 25(6): 865-868.

参考文献

[1] Garbuzenko DV, Arefyev NO. Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis: An update and review of the literature. J Evid Based Med,2020,13(4):313-324.
[2] El-Boghdady NA, Kamel MA, El-Shamy RM. Omeprazole and spirulina platensis ameliorate steatohepatitis in experimental nonalcoholic fatty liver disease. Metab Syndr Relat Disord, 2020,18(9):426-434.
[3] 董肖肖, 马学学, 郭芳. 奥曲肽联合凝血酶治疗血吸虫性肝硬化上消化道出血的疗效观察. 中华地方病学杂志, 2020, 39(6):425-429.
[4] Hidaka H, Tanabe S, Uojima H, et al. Long-term observation in patients with esophageal varices after endoscopic variceal ligation accompanied with 24-hour pH monitoring. Hepatol Res, 2020 ,50(11):1255-1263.
[5] 中华医学会肝病学分会.肝硬化腹水及相关并发症的诊疗指南.实用肝脏病杂志,2018,21(1):21-31.
[6] 中华医学会消化内镜学分会.食管胃静脉曲张内镜下诊断和治疗规范试行方案(2003年). 中华消化内镜杂志, 2004, 21(3):149-151.
[7] Jie C,Zhou XQ,Li LM,et al. Long term efficacy of endoscopic ligation plus cyanoacrylate injection for variceal bleeding:with or without sclerotherapy. J Digest Dis, 2016, 17(4):252-259.
[8] Uceda PV, Peralta Rodriguez J, Vela H,et al. Management of superior vena cava occlusion causing bleeding "downhill" esophageal varices. J Endovasc Ther, 2021 ,28(3):469-473.
[9] Calleja LF, Yoval-Sánchez B, Hernández-Esquivel L,et al. Activation of ALDH1A1 by omeprazole reduces cell oxidative stress damage. FEBS J, 2021 ,288(13):4064-4080.
[10] Greenmyer JR, Burd L, Kobrinsky NL. Octreotide for the treatment of abnormal uterine bleeding in women with bleeding and clotting disorders. Int J Gynaecol Obstet, 2021 ,153(1):171-174.
[11]Drolz A, Schramm C, Seiz O,et al. Risk factors associated with bleeding after prophylactic endoscopic variceal ligation in cirrhosis. Endoscopy, 2021 ,53(3):226-234.
[12] 凌晶, 王娟. 胃镜下聚桂醇注射治疗肝硬化并发食管静脉曲张患者临床疗效研究. 实用肝脏病杂志, 2019, 22(3):92-95.
[13] Wilson TJ, Baran DA, Herre JM,et al. Gastrointestinal bleeding rates in left ventricular assist device population reduced with octreotide utilization. ASAIO J, 2021,67(9):989-994.
[14] Kim JH, Park SW, Jung JH,et al. Bedside risk-scoring model for predicting 6-week mortality in cirrhotic patients undergoing endoscopic band ligation for acute variceal bleeding. J Gastroenterol Hepatol, 2021,36(7):1935-1943.
[15] Sun X, Zhang A, Zhou T,et al. Partial splenic embolization combined with endoscopic therapies and NSBB decreases the variceal rebleeding rate in cirrhosis patients with hypersplenism: a multicenter randomized controlled trial. Hepatol Int, 2021,15(3):741-752.
[16] 吴一鸣, 周丽云, 章丽芳,等. 腹腔镜联合胃镜治疗肝硬化门静脉高压症食管胃底静脉曲张破裂出血的疗效分析. 中华肝胆外科杂志, 2020, 26(3):173-176.
[17] Xu SH, Wu F, Guo LH, et al. Liver fibrosis index-based nomograms for identifying esophageal varices in patients with chronic hepatitis B related cirrhosis. World J Gastroenterol, 2020,26(45):7204-7221.
[18] Khodir AE, Said E. Nifuroxazide attenuates experimentally-induced hepatic encephalopathy and the associated hyperammonemia and cJNK/caspase-8/TRAIL activation in rats. Life Sci, 2020, 252(1):117610.
[19] N'Diaye EN, Cook R, Wang H, et al. Extracellular BMP1 is the major proteinase for COOH-terminal proteolysis of type I procollagen in lung fibroblasts. Am J Physiol Cell Physiol, 2021,320(2):C162-C174.
[20] Alves da Silva J, Falcão D, Maia L, et al. Acute variceal bleeding and out-of-hours endoscopy: Evaluation of an emergency care setting according to Baveno VI guidelines adherence. Dig Liver Dis, 2021,53(10):1320-1326.
[21] Adam EH, Mohlmann M, Herrmann E, et al. Assessment of hemostatic profile in patients with mild to advanced liver cirrhosis. World J Gastroenterol, 2020, 26(17):2097-2110.
[22] Pfisterer N, Unger LW, Reiberger T. Clinical algorithms for the prevention of variceal bleeding and rebleeding in patients with liver cirrhosis. World J Hepatol, 2021,13(7):731-746.

内镜下套扎术联合奥美拉唑和奥曲肽治疗肝硬化并发食管静脉曲张首次出血患者短期疗效分析^*

Short-term hemostatic effect of endoscopic variceal ligation and omeprazole and octreotide combination in the treatment of cirrhotics with first esophageal varices bleeding

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