内镜曲张静脉套扎术联合生长抑素和奥美拉唑治疗乙型肝炎肝硬化并发食管胃静脉曲张破裂出血患者对肝静脉压力梯度的影响*

doi:10.3969/j.issn.1672-5069.2026.03.015

摘要/Abstract

摘要： 目的观察内镜曲张静脉套扎术(EVL)联合生长抑素和奥美拉唑治疗乙型肝炎肝硬化并发食管胃静脉曲张破裂出血(EVB)患者的止血效果及其对肝静脉压力梯度(HVPG)的影响。方法 2022年1月～2025年1月我院收治的乙型肝炎肝硬化并发EVB患者76例,被随机分为对照组38例和观察组38例,分别予以EVL或EVL联合生长抑素和奥美拉唑治疗。经颈静脉穿刺检测肝静脉游离压和肝静脉楔压,并计算HVPG。采用ELISA法检测血清丙二醛、皮质醇和C反应蛋白水平。结果观察组输血量、止血时间、72 h再出血率和住院日分别为(2.1±0.4)U、(1.8±0.7)h、2.6%和(9.1±2.0)d,与对照组【分别为(2.4±0.5)U、(2.2±0.6)h、7.9%和(10.8±2.4)d】比,均无显著性差异(P＜0.05);观察组HVPG为(6.6±1.4)mmHg,显著低于对照组【(8.3±1.8)mmHg,P＜0.05】;观察组血清丙二醛、皮质醇和C反应蛋白水平分别为(30.1±5.2)U/L、(264.3±15.4)μg/L和(9.7±1.9)mg/L,均显著低于对照组【分别为(40.5±6.4)U/L、(297.8±19.1)μg/L和(14.2±3.3)mg/L,P＜0.05】。结论在EVL治疗乙型肝炎肝硬化并发EVB患者后及时应用生长抑素联合奥美拉唑继续巩固治疗可能有助于降低门静脉压,防止再出血。

关键词: 肝硬化, 食管胃静脉曲张破裂出血, 内镜曲张静脉套扎术, 生长抑素, 奥美拉唑, 肝静脉压力梯度, 治疗

Abstract: Objective The aim of this study was to investigate impact of intravenous somatostatin and omeprazole treatment on hepatic venous pressure gradient (HVPG) in patients with hepatitis B-induced liver cirrhosis (LC) and esophagogastric variceal bleeding (EVB) after endoscopic variceal ligation (EVL). Methods 76 consecutive patients with hepatitis B-induced LC and complicated EVB were encountered in our hospital between January 2022 and January 2025, were randomly assigned to underwent EVL in 38 cases in control, or to receive intravenous somatostatin and omeprazole treatment after EVL in another 38 cases in observation. The free pressure and wedge pressure of hepatic vein were detected by jugular vein puncture, and HVPG was calculated. Serum malondialdehyde, cortisol and C-reactive protein (CRP) levels were detected by ELISA. Results Blood transfusion volume, hemostasis time, incidence of re-bleeding at 72 hours and hospital stay in the observation group were(2.1±0.4)U, (1.8±0.7)h, 2.6% and (9.1±2.0)d, all not significantly different as compared to [(2.4±0.5)U, (2.2±0.6)h, 7.9% and (10.8±2.4)d] in the control group (P＜0.05); HVPG in the observation group was (6.6±1.4)mmHg, much lower than [(8.3±1.8)mmHg, P＜0.05] in the control; serum malondialdehyde, cortisol and CRP levels were(30.1±5.2)U/L, (264.3±15.4)μg/L and (9.7±1.9)mg/L, all significantly lower than [(40.5±6.4)U/L, (297.8±19.1)μg/L and (14.2±3.3)mg/L, respectively, P＜0.05] in the control group. Conclusion The maintained intravenous administration of somatostatin and omeprazole after EVL might decreased HVPG, which might decrease the risk of re-bleeding in patients with LC and EVB.

Key words: Liver cirrhosis, Esophagogastric variceal bleeding, Endoscopic variceal ligation, Hepatic venous pressure gradient, Somatostatin, Octreotide, Treatment

章丽, 黎军, 黎源, 覃永娟. 内镜曲张静脉套扎术联合生长抑素和奥美拉唑治疗乙型肝炎肝硬化并发食管胃静脉曲张破裂出血患者对肝静脉压力梯度的影响^*[J]. 实用肝脏病杂志, 2026, 29(3): 377-380.

Zhang Li, Li Jun, Li Yuan, et al. Influences of intravenous somatostatin and omeprazole treatment on hepatic venous pressure gradient in patients with hepatitis B-induced liver cirrhosis and esophagogastric variceal bleeding after EVL[J]. Journal of Practical Hepatology, 2026, 29(3): 377-380.

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内镜曲张静脉套扎术联合生长抑素和奥美拉唑治疗乙型肝炎肝硬化并发食管胃静脉曲张破裂出血患者对肝静脉压力梯度的影响^*

Influences of intravenous somatostatin and omeprazole treatment on hepatic venous pressure gradient in patients with hepatitis B-induced liver cirrhosis and esophagogastric variceal bleeding after EVL

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