内镜下套扎术后应用卡维地洛治疗肝硬化并发食管胃底静脉曲张破裂出血患者疗效研究

doi:10.3969/j.issn.1672-5069.2021.03.025

摘要/Abstract

摘要： 目的探讨采取在内镜下套扎术(EVL)后应用卡维地洛治疗肝硬化食管胃底静脉曲张破裂出血(EVB)患者的疗效。方法 2017年12月～2019年12月我院收治的肝硬化并发EVB患者72例,采用随机数字表法分为对照组35例,行EVL治疗,和观察组37例,采用EVL后给予卡维地洛治疗,均随访12个月。采用ELISA法检测血清超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)。结果在急性期,本组观察组和对照组患者分别死亡2例和4例,差异无统计学意义(P>0.05);两组输血量和止血时间无显著性差异(P>0.05),但观察组患者住院日显著短于对照组【(10.4±2.4)d对(12.1±2.2)d,P<0.05】;治疗前和治疗后2 w,两组血常规和肝功能指标水平无显著性差异(P>0.05);治疗前,两组血清CRP、IL-6和TNF-α水平无显著性差异(P>0.05),在治疗后2 w,观察组血清CRP、IL-6和TNF-α水平分别为(4.9±0.32)mg/l、(20.4±9.4)pg/ml和(25.1±8.1)pg/ml,显著低于对照组【分别为(6.3±5.5)mg/l、(28.6±7.6)pg/ml和(34.7±9.3)pg/ml,P<0.05】;两组不良反应发生率无显著性差异(42.9%对48.4%,P>0.05);在随访3 m和6 m,观察组再出血率分别为11.4%和20.0%,显著低于对照组(分别为29.0%和45.2%,P<0.05)。结论在EVL术后应用卡维地洛治疗肝硬化并发EVB患者疗效较好,能减少再出血发生率,值得临床进一步验证和随访观察。

关键词: 肝硬化, 食管胃底静脉曲张破裂出血, 内镜下套扎, 卡维地洛, 治疗

Abstract: Objective The aim of this study was to observe the efficacy of endoscopic variceal ligation (EVL) and carvedilol maintenance in the treatment of patients with liver cirrhosis and complicated esophagogastric variceal bleeding (EVB). Methods A total of 72 patients with liver cirrhosis and EVB were enrolled in our hospital between December 2017 and December 2019, and were randomly divided into control (n=35) , receiving EVL, and observation group (n=37), receiving carvedilol maintenance after EVL. All patients were followed-up for 12 months. Serum high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected by ELISA.Results Two and four patients in the observation and control group respectively in our series died from emergent bleeding (P>0.05); there were no significant differences in the blood transfusion volume and hemostasis time between the two groups (P>0.05), but the hospital stay in observation group was significantly shorter than that in control group [(10.4±2.4)d vs.(12.1±2.2)d, P<0.05]; there were no significant differences as respect to blood routine and liver function tests at presentation and 2 weeks after treatment between the two groups (P>0.05); at admission, there were no significant differences with respect to serum CRP, IL-6 and TNF-α levels between the two groups (P>0.05), while 2 weeks after the treatment, serum CRP, IL-6 and TNF-α levels in the observation group were (4.9±0.32)mg/l, (20.4±9.4)pg/ml and (25.1±8.1)pg/ml, significantly lower than [(6.3±5.5)mg/l, (28.6±7.6)pg/ml and (34.7±9.3)pg/ml, respectively, P<0.05] in the control; there were no significant differences in the incidence of adverse reactions between the two groups (42.9% vs. 48.4%, P>0.05); at the end of 3 months and 6 months of follow-up, the re-bleeding rates were 11.4% and 20.0% in observation group, significantly lower than 29.0% and 45.2% in the control group (P<0.05).Conclusion The carvedilol maintenance after EVL has a good efficacy in the treatment of patients with liver cirrhosis and EVB, which is worthy of further clinical investigation.

Key words: Liver cirrhosis, Esophagogastric variceal bleeding, Endoscopic variceal ligation, Carvedilol, Therapy

伍畅, 张远安, 彭春芬. 内镜下套扎术后应用卡维地洛治疗肝硬化并发食管胃底静脉曲张破裂出血患者疗效研究[J]. 实用肝脏病杂志, 2021, 24(3): 403-406.

Wu Chang, Zhang Yuan’an, Peng Chunfen. Efficacy of endoscopic variceal ligation and carvedilol maintenance in the treatment of patients with liver cirrhosis and esophagogastric variceal bleeding[J]. Journal of Practical Hepatology, 2021, 24(3): 403-406.

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