内镜联合生长抑素或特利加压素治疗乙型肝炎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.1672-5069.2026.03.018

摘要/Abstract

摘要： 目的比较研究内镜联合生长抑素或特利加压素治疗乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血(EVB)患者的临床效果。方法 2022年6月～2025年6月我院收治的乙型肝炎肝硬化并发EVB患者48例,均接受急诊内镜下曲张静脉套扎术(EVL)或组织黏合剂注射治疗,其中22例观察组接受生长抑素静脉泵入,另26例对照组接受特利加压素静脉泵入治疗。常规行胃镜检查评估曲张静脉(EV)分级,计算Child-Pugh和MELD评分。结果观察组初始止血成功、24 h持续止血和72 h持续止血率分别为50.0%、95.5%和100.0%,均显著高于对照组的34.6%、76.9%和84.6%,而输注红细胞悬液为(2.1±0.9)U,显著少于对照组【(3.4±1.2)U,P<0.05】;内镜复查发现观察组EV明显改善率为77.3%,显著高于对照组的53.8%(P<0.05);观察组Child-Pugh评分和MELD评分下降分别为(-0.9±0.4)和(-1.8±0.7),均显著高于对照组【分别为(-0.3±0.1)和(-0.6±0.3),P<0.05】,肝性脑病、30 d内再出血和30 d内死亡率分别为4.5%、9.1%和4.5%,均显著低于对照组的19.2%、30.8%和30.8%(P<0.05),住院时间为(10.2±2.1)d,显著短于对照组【(13.5±2.8)d,P<0.05】。结论内镜联合生长抑素或特利加压素治疗乙型肝炎肝硬化并发EVB患者止血成功率高,但需注重止血后管理和预防再出血。

关键词: 肝硬化, 食管胃底静脉曲张破裂出血, 内镜下曲张静脉套扎术, 组织胶注射, 生长抑素, 特利加压素, 治疗

Abstract: Objective This study aimed to investigate clinical efficacy of endoscopic therapy in combination with somatostatin or terlipressin in treatment of patients with hepatitis B-induced liver cirrhosis (LC) and esophagogastric variceal bleeding (EVB). Methods Forty-eight patients with hepatitis B-induced LC and EVB were encountered in our hospital between June 2022 and June 2025, and all underwent endoscopic variceal ligation or tissue glue injection. Intravenous somatostatin was given in 22 cases (observation group) or terlipressin was given in 26 cases (control group). Esophagogastric varices (EV) grading was evaluated by gastroscopy, and Child-Pugh and MELD scores were obtained routinely. Results Initial hemostasis, hemostasis at 24 hours and at 72 hours in the observation group were 50.0%, 95.5% and 100.0%, all significantly higher than 34.6%, 76.9% and 84.6%, while red blood cell suspension infused was (2.1±0.9)U, significantly less than [(3.4±1.2)U, P<0.05] in the control group; re-examination of gastroscopy found improved EV grading in the observation group was 77.3%, much higher than 53.8% in the control group(P<0.05); decreased Child-Pugh and MELD scores in the observation group were (-0.9±0.4) and (-1.8±0.7), both much higher than [(-0.3±0.1) and (-0.6±0.3), respectively, P<0.05], while incidence of hepatic encephalopathy, 30-day re-bleeding and 30-day mortality were 4.5%, 9.1% and 4.5%, all much lower than 19.2%, 30.8% and 30.8%(P<0.05), and hospital stay was (10.2±2.1)d, much shorter than [(13.5±2.8)d, P<0.05] in the control group. Conclusion Emergency endoscopic therapy followed by intravenous somatostatin or terlipressin administration in dealing with patients with LC and EVB is certainly efficacious, with high successful hemostasis and short-term survivals.

Key words: Liver cirrhosis, Esophagogastric variceal bleeding, Somatostatin, Terlipressin, Endoscopic varices ligation, Therapy

江浩, 唐榛, 庄鸣, 李路. 内镜联合生长抑素或特利加压素治疗乙型肝炎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, 2026, 29(3): 389-392.

Jiang Hao, Tang Zhen, Zhuang Ming, et al. Clinical efficacy of endoscopic therapy in combination with somatostatin or terlipressin in treatment of patients with hepatitis B-induced liver cirrhosis and esophagogastric variceal bleeding[J]. Journal of Practical Hepatology, 2026, 29(3): 389-392.

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内镜联合生长抑素或特利加压素治疗乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者疗效研究^*

Clinical efficacy of endoscopic therapy in combination with somatostatin or terlipressin in treatment of patients with hepatitis B-induced liver cirrhosis and esophagogastric variceal bleeding

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