Abstract: Objective The purpose of this study was to investigate the efficacy of terlipressin and somatostatin combination in the treatment of cirrhotic patients with upper gastrointestinal bleeding, and serum glucagon (GCG) and nitric oxide (NO) level changes. Methods 104 hepatitis B cirrhotic patients with upper gastrointestinal bleeding were enrolled in our hospital and were randomly divided into observation (n=52) and control group (n=52). The patients in the control group were treated with somatostatin, and those in the observation group were treated with terlipressin based on somatostatin. The regimen lasted for3 days. Serum high-sensitivity C-reactive protein (hs-CRP), cortisol (COR), glucagon (GCG) and nitric oxide (NO) were assayed. Results The stopping time of hematemesis, stable blood pressure and hemostatic time in the combination group were (5.2±2.1)h, (11.9±3.1)h and (21.9±7.1)h, significantly shorter than 【(8.5±2.3)h, (15.5±5.3)h and (30.5±5.3)h, respectively, P<0.05】 in the control, and the the effective rate in the former was 94.2%, much higher than 78.9%(P<0.05) in the latter; after treatment, the blood hemoglobin was (107.3±19.4) g/L, much higher than [(98.6±17.9) g/L, P<0.05], the hematocrit was (37.6±5.8)%, much higher than【(29.4±6.5)%, P<0.05】 and platelet counts was (101.4±19.2)×10⁹/L, significantly higher than 【(92.8±18.4)×10⁹/L, P<0.05】 in the control; the portal vein blood flow was (481.3±91.7) mL/min, much slower than [(608.6±98.5) mL/min, P<0.05], the splenic vein blood flow was (231.4±44.2) mL/min, much slower than [(302.8±52.4) mL/min, P<0.05], the diameter of portal vein was(12.6±1.1)mm, significantly lower than 【(14.7±1.0)mm, P<0.05】 and the splenic vein diameter was (9.2±0.8)mm, much lower than 【(12.6±0.9)mm, P<0.05】 in the control; serum hs-CRP level was (6.5±1.1) μg/L, much lower than 【(12.3±3.2)μg/L, P<0.05】, serum COR level was (281.2±12.6)μg/L, much lower than 【(318.7±14.9)g/L, P<0.05】 and serum GCG level was (149.8±17.4)ng/L, much lower than 【(182.4±19.3)ng/L, P<0.05】, while serum NO level was (119.4±10.7)μmol/L, significantly higher than 【(96.9±12.6)μmol/L, P<0.05】 in the control. Conclusion The successful hemostasis is obtained by administration of terlipressin and somatostatin combination in cirrhotic patients with variceal hemorrhage, which might reduce blood GCG and elevate NO levels.

Key words: Liver cirrhosis, Variceal hemorrhage, Terlipressin, Somatostatin, Glucagon, Nitric oxide, Therapy