关键词: 食管静脉曲张破裂出血, 硬化治疗, 急性心肌损伤, 危险因素

Abstract: Objective This study aimed to investigate prevalence and risk factors of myocardial injury (MCI) in patients with liver cirrhosis complicated with esophageal variceal bleeding (EVB) after endoscopic sclerotherapy. Methods Ninety-eight patients with decompensated liver cirrhosis and EVB were urgently admitted to our hospital between January 2023 and June 2024, 66 patients received urgent gastroscopic varicose vein sclerotherapy and another 32 patients were treated conventionally with internal medicine. Serum troponin (CTnI), myoglobin(MYO) and creatine kinase isoenzyme (CK-MB), and B-type natriuretic peptide (BNP) levels were detected routinely. Multivariate Logistic regression analysis was applied to find risk factors for MCI. Results Within 12 hours after admission, the incidence of MCI in the sclerotherapy group was 42.4%, much higher than 28.1%(P<0.05) in internal medicine-treated group; serum CTnI, MYO and CK-MB levels in sclerotherapy group were (0.028±0.018)μg/L, (55.1±4.4)μg/L and (35.2±18.6)U/L, all significantly higher than [(0.008±0.003)μg/L, (48.3±4.5)μg/L and (17.9±11.5)U/L, respectively, P＜0.05] in the control; percentages of cardiac disease history, diabetes, Child class B/C in patients with MCI were 65.0%, 69.2% and 89.2%, all significantly higher than 35.0%, 20.8% and 76.3%(P＜0.05), the age, shock index, serum BNP level, operation time and serum creatinine (sCr) level were(66.4±12.3)yr, (1.2±0.6), (178.6±22.8)pg/ml, (18.9±3.5)min and (97.9±8.6)μmol/L, all much greater or higher than [(57.4±9.2)yr, (0.7±0.4), (119.4±15.7)pg/ml, (15.4±3.8)min and (77.2±8.9)μmol/L, respectively, P＜0.05], while serum albumin level was (25.8±3.2)g/L, much lower than [(33.4±4.3)g/L, P＜0.05] in those without MCI; multivariate Logistic analysis showed that age, Child class, shock index, operation time, cardiac disease, diabetes, serum BNP, albumin and sCr levels were all the independent risk factors for occurrence of MCI (P＜0.05). Conclusion The incidence of acute myocardial injury in patients with cirrhosis complicated with EVB undergoing sclerotherapy is high, and the risk factors are diverse. Clinicians should pay more attention to preoperative assessment and intraoperative monitoring, and take measures to prevent and manage it.

Key words: Esophageal variceal bleeding, Endoscopic sclerotherapy, Acute myocardial damage, Risk factor