关键词: 肝硬化, 食管胃静脉曲张破裂出血, 内镜下套扎术, 特利加压素, 治疗

Abstract: Objective The aim of this study was to observe the efficacy of terlipressin treatment after endoscopic variceal ligation (EVL) in the treatment of patients with liver cirrhosis (LC) complicated by esophageal and gastric variceal bleeding (EGVB). Methods 89 patients with LC and complicated EGVB were enrolled in our hospital between December 2018 and July 2022, and were divided into control (n=45) and observation group (n=44 cases). All patients underwent EVL, and those in the observation group were treated with intravenous terlipressin for three days after EVL. The cardiac output (CO), cardiac index (CI), portal venous flow (PVF) and esophageal variceal diameter (EVD) were detected by color Doppler ultrasonography. Serum motilin, gastrin and somatostatin levels were determined by ELISA and serum malondialdehyde (MDA), lipid hydrogen peroxide (LHP) and glutathione peroxidase (GSH-Px) levels were detected by radioimmunoassay. Results During the treatment period, three patients (6.8%) in the observation and nine patients (20.0%) died of hemorrhagic shock; at day three after admission, the CI, EVD and PVF in 41 patients in the observation were (3.0±0.6)L/(min.m²),(3.3±0.6)mm and (3.4±0.6)L/min, all significantly smaller than [(3.5±0.6)L/(min.m²), (4.5±0.9)mm and (4.1±0.6)L/min, respectively, P<0.05] in 36 patients in the control; serum motilin, gastrin and somatostatin levels in the observation group were (207.5±25.1)ng/L,(82.4±8.6)ng/L and (11.9±1.5)ng/L, much lower than [(241.1±24.8)ng/L, (98.0±8.2)ng/L and (16.8±1.3)ng/L, P<0.05] in the control; serum MDA and LHP levels were (22.0±4.3)μmol/L and (9.7±2.4)μmol/L, both significantly lower than [(31.8±4.2)μmol/L and (14.4±2.6)μmol/L, P<0.05], while serum GSH-Px level was (29.7±3.6)U/ml, much higher than [(20.8±4.0)U/ml, P<0.05] in the control; at the end of six month follow-up, the re-bleeding occurred in one case (2.4%) in the observation, much lower than 7 cases (19.4%, P<0.05) in the control, while there was no significant difference as respect to relapse of varies between the two groups (4.9% vs. 19.4%, P>0.05). Conclusion The administration of terlipressin after EVL in the treatment of patients with LC and EGVB could reduce the rebleeding rate and recurrence of varies, which might be related to the improvement of hemodynamics, inhibition of gastrointestinal hormone secretions and relief of oxidative stress response.

Key words: Liver cirrhosis, Esophageal and gastric variceal bleeding , Endoscopic variceal ligation, Terlipressin, Therapy