特利加压素联合生长抑素治疗肝硬化食管胃静脉曲张出血的效果分析

李晓路; 丁惠国; 曾阿娟; 吕新月; 李磊

doi:10.3969/j.issn.1001-5256.2020.06.017

特利加压素联合生长抑素治疗肝硬化食管胃静脉曲张出血的效果分析

DOI: 10.3969/j.issn.1001-5256.2020.06.017

首都医科大学附属北京佑安医院肝病消化中心

基金项目:

十三五“艾滋病与病毒性肝炎等重大传染病防治”科技重大专项(2017ZX10203202003008)；

详细信息

中图分类号: R575.2
计量
- 文章访问数: 1405
- HTML全文浏览量: 55
- PDF下载量: 213
- 被引次数: 18
出版历程
- 出版日期: 2020-06-20

Clinical effect of terlipressin combined with somatostatin in treatment of esophagogastric variceal bleeding with liver cirrhosis

Research funding:

摘要

摘要:
目的探析特利加压素联合生长抑素治疗肝硬化食管胃静脉曲张出血（EVB）患者的效果。方法回顾性分析2017年9月-2019年2月在首都医科大学附属北京佑安医院肝病消化中心住院治疗的73例肝硬化EVB患者的临床资料。在抑酸对症治疗的基础上,加用生长抑素治疗的患者43例,加用特利加压素治疗的8例,加用特利加压素联合生长抑素治疗的22例。比较3组患者24 h止血成功率、止血时间、早期再出血率、迟发性再出血率、并发急性肾损伤（AKI）治疗改善率及半年累积生存率情况。符合正态分布的计量资料3组间比较采用单因素方差分析;非正态分布的计量资料3组间比较采用Kruskal-Wallis H秩和检验。计数资料3组间比较采用χ2检验。采用累积风险函数（CIF）描述病死率,采用竞争风险模型（Gray’s Test）检验3组生存率的差异。结果联合治疗组、生长抑素组、特利加压素组24 h内止血成功率分别为54. 5%、41. 9%、37. 5%,止血时间分别为1. 00（1. 00～3. 00）d、2. 00（1. 00～3. 00） d、2. 00（1. 00～3. 00） d,早期再出血率...
- 肝硬化 /
- 高血压,门静脉 /
- 食管和胃静脉曲张 /
- 特利加压素 /
- 生长抑素
Abstract:
Objective To investigate the clinical effect of terlipressin combined with somatostatin in the treatment of esophagogastric variceal bleeding( EVB) in patients with liver cirrhosis. Methods A retrospective analysis was performed for the clinical data of 73 patients with liver cirrhosis and EVB who were treated in Department of Gastronenterology and Hepatology,Beijing YouAn Hospital,Capital Medical University,from September 2017 to February 2019. In addition to anti-acid therapy,43 patients were treated with somatostatin,8 patients were treated with terlipressin,and 22 patients were treated with terlipressin combined with somatostatin. The three groups were compared in terms of 24-hour success rate of hemostasis,hemostatic time,early rebleeding rate,delayed rebleeding rate,improvement rate of acute kidney injury( AKI),and half-year cumulative survival rate. A one-way analysis of variance was used for comparison of normally distributed continuous data between the three groups,and the Kruskal-Wallis H rank sum test was used for comparison of non-normally distributed continuous data between the three groups; the chi-square test was used for comparison of categorical data between groups. The cumulative incidence function was used to describe mortality rate,and a competing risk model( Gray's Test) was used for comparison of survival rates between the three groups. Results There were no significant differences between the combination group,the somatostatin group,and the terlipressin group in 24-hour success rate of hemostasis( 54. 5%,41. 9%,and 37. 5%,respectively),hemostatic time [1. 00( 1. 00-3. 00) d,2. 00( 1. 00-3. 00) d,and 2. 00( 1. 00-3. 00) d,respectively],early rebleeding rate( 25%,27. 5%,and 16. 7%,respectively),and delayed rebleeding rate( 16. 7%,27. 3%,and 40%,respectively)( all P > 0. 05). There was no significant difference in the improvement rate of AKI patients after treatment between the combination group and the somatostatin group( 100% vs 50%,P = 0. 429).There was no significant difference in the half-year cumulative survival rate between the three groups( SHR = 1. 40,95% confidence interval:0. 60-3. 27,P = 0. 436). Conclusion Terlipressin combined with somatostatin,somatostatin alone,and terlipressin alone can effectively control EVB in liver cirrhosis and have similar clinical effects. Compared with somatostatin alone,somatostatin combined with terlipressin has a potential advantage in improving AKI.
- liver cirrhosis /
- hypertension,portal /
- esophageal and gastricvarices /
- terlipressin /
- somatostatin

HTML全文

参考文献(22)

[1] Chinese Society of Hepatology,Chinese Medical Association;Chinese Society of Gastroenterology,Chinese Medical Association; Chinese Society of Endoscopy,Chinese Medical Association. Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol,2016,32(2):203-219.(in Chinese)中华医学会肝病学分会，中华医学会消化病学分会，中华医学会内镜学分会．肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]．临床肝胆病杂志，2016,32(2):203-219.

[2] European Association for the Study of the Liver. EASL Clinical practice guidelines for the management of patients with decompensated cirrhosis[J]. J Hepatol,2018,69(2):406-460.

[3] XIA ZX,ZHANG ZF. The efficacy of Tripsin combined growth inhibition in treatment of decompensated liver cirrhosis combined with upper gastrointestinal bleeding[J]. Drug Eval Res,2017,40(12):1745-1748.(in Chinese)夏正新，张志飞．特利加压素联合生长抑素治疗肝硬化失代偿期并急性上消化道大出血的疗效观察[J]．药物评价研究，2017,40(12):1745-1748.

[4] ZHANG L,ZHANG R,LIU FL,et al. Terlipressin combined with somatostatin in treatment of hemorrhage of esophagogastric varices due to portal hypertension in liver cirrhosis[J]. Chin J Bases Clin Gen Surg,2014,21(11):1436-1438.(in Chinese)张磊，章锐，刘飞龙，等．特利加压素联合生长抑素治疗门静脉高压食管胃底曲张静脉破裂出血[J]．中国普外基础与临床杂志，2014,21(11):1436-1438.

[5] KRAG A,BORUP T,MLLER S,et al. Efficacy and safety of terlipressin in cirrhotic patients with variceal bleeding or hepatorenal syndrome[J]. Adv Ther,2008,25(11):1105-1140.

[6] ANGELI P,GINES P,WONG F,et al. Diagnosis and management of acute kidney injury in patients with cirrhosis:Revised consensus recommendations of the International Club of Ascites[J]. Gut,2015,64(4):531-537.

[7] GARCIA-TSAO G,BOSCH J. Management of varices and variceal hemorrhage in cirrhosis[J]. N Engl J Med,2010,362(9):823-832.

[8] GARCA-PAGN JC,REVERTER E,ABRALDES JG,et al. Acute variceal bleeding[J]. Semin Respir Crit Care Med,2012,33(1):46-54.

[9] PEDRETTI G,ELIA G,CALZETTI C,et al. Octreotide versus terlypressin in acute variceal hemorrhage in liver cirrhosis. Emergency control and prevention of early rebleeding[J]. Clin Investig,1994,72(9):653-659.

[10] HUNG TH,TSAI CC,TSENK GC,et al. No mortality difference following treatment with terlipressin or somatostatin in cirrhotic patients with gastric variceal hemorrhage[J]. Saudi J Gastroenterol,2016,22(3):220-225.

[11] SEO YS,PARK SY,KIM MY,et al. Lack of difference among terlipressin,somatostatin,and octreotide in the control of acute gastroesophageal variceal hemorrhage[J]. Hepatology,2014,60(3):954-963.

[12] SRIDHARAN K,SIVARAMAKRISHNAN G. Vasoactive agents for the management of variceal bleeding:A mixed treatment comparison network meta-analysis and trial sequential analysis of randomized clinical trials[J]. Drug Res(Stuttg),2019,69(9):487-495.

[13] JINDAL A,BHADORIA AS,MAIWALL R,et al. Evaluation of acute kidney injury and its response to terlipressin in patients with acute-on-chronic liver failure[J]. Liver Int,2016,36(1):59-67.

[14] ZANG H,LIU F,LIU H,et al. Incidence,risk factors and outcomes of acute kidney injury(AKI)in patients with acuteon-chronic liver failure(ACLF)of underlying cirrhosis[J].Hepatol Int,2016,10(5):807-818.

[15] SUN DQ,ZHENG CF,LIU WY,et al. AKI-CLIF-SOFA:A novel prognostic score for critically ill cirrhotic patients with acute kidney injury[J]. Aging(Albany NY),2017,9(1):286-296.

[16] SHETTY S,NAGARAJU SP,SHENOY S,et al. Acute kidney injury in patients with cirrhosis of liver:Clinical profile and predictors of outcome[J]. Indian J Gastroenterol,2018,37(3):248-254.

[17] SHI X,ZHU P,YAN G,et al. Clinical characteristics and longterm outcome of acute kidney injury in patients with HBV-related acute-on-chronic liver failure[J]. J Viral Hepat,2016,23(11):920-929.

[18] DURAND F,OLSON JC,NADIM MK. Renal dysfunction and cirrhosis[J]. Curr Opin Crit Care,2017,23(6):457-462.

[19] BUCSICS T,KRONES E. Renal dysfunction in cirrhosis:Acute kidney injury and the hepatorenal syndrome[J]. Gastroenterol Rep(Oxf),2017,5(2):127-137.

[20] ZHAI XR,XU X,CHEN J,et al. Effect of response at 48 hours of treatment of acute kidney injury on short-term prognosis of hepatitis B virus-associated acute-on-chronic liver failure[J]. J Clin Hepatol,2019,35(9):2001-2005.(in Chinese)翟兴冉，许祥，陈婧，等．急性肾损伤治疗48小时应答与否对HBV相关慢加急性肝衰竭短期预后的影响[J]．临床肝胆病杂志，2019,35(9):2001-2005.

[21] CHENG Y,LAN Y,JIA QB. Tenet vasopressin hemodynamics in liver cirrhosis patients with upper gastrointestinal bleeding[J]. J Clin Exp Med,2018,17(22):2419-2422.(in Chinese)程远，兰宇，贾绮滨．特利加压素对肝硬化上消化道出血患者血流动力学的影响[J]．临床和实验医学杂志，2018,17(22):2419-2422.

[22] ARORA V,MAIWALL R,RAJAN V,et al. Terlipressin is superior to noradrenaline in the management of acute kidney injury in acute on chronic liver failure[J]. Hepatology,2020,71(2):600-610.

施引文献

期刊类型引用(18)

1.	丁喜，李华. 特利加压素与托伐普坦在肝硬化并发顽固性腹水患者治疗中的疗效观察. 现代诊断与治疗. 2024(07): 1000-1002 . 百度学术
2.	武少林. 内镜套扎术联合生长抑素治疗肝硬化食管静脉曲张出血患者的效果. 中外医学研究. 2024(19): 104-108 . 百度学术
3.	仝国栋，杨梅. 特利加压素联合雷贝拉唑对肝硬化门静脉高压食管胃静脉曲张出血患者凝血功能及血清炎症因子水平的影响. 药品评价. 2024(08): 1023-1026 . 百度学术
4.	胡青山. 特利加压素联合生长抑素及奥美拉唑治疗肝硬化食管胃底静脉曲张破裂出血的临床效果观察. 药品评价. 2023(01): 84-87 . 百度学术
5.	龚星光，赵孝荣，李冬妮，李庆辉，李钦，叶杏，粟仑. 特利加压素与生长抑素对肝硬化合并食管胃底静脉曲张破裂出血患者肾损伤的预防效果对比. 川北医学院学报. 2023(05): 613-615+625 . 百度学术
6.	徐祖云. 生长抑素联合特利加压素对肝硬化急性上消化道出血患者凝血纤溶功能指标及预后的影响. 现代诊断与治疗. 2023(17): 2583-2585 . 百度学术
7.	曾金生，张利军，聂美亮. 生长抑素治疗肝硬化致食管及胃底静脉破裂出血的临床疗效观察. 江西医药. 2022(02): 173-174+177 . 百度学术
8.	张辉，陶洋，杨祝春. 内镜套扎联合生长抑素对肝硬化食管静脉曲张出血的疗效. 系统医学. 2022(04): 55-58 . 百度学术
9.	史良玉，吉婷婷. 特利加压素联合生长抑素治疗肝硬化并急性上消化道出血的临床效果. 临床医学研究与实践. 2022(32): 37-41 . 百度学术
10.	朱玉侠，赵世民. 白蛋白与特利加压素联合治疗肝肾综合征患者的临床效果及对尿素氮水平的影响研究. 贵州医药. 2022(09): 1410-1411 . 百度学术
11.	李淑芹，宋玮佳，蒋博睿. 特利加压素联合生长抑素治疗肝硬化食管胃底静脉曲张破裂出血的效果. 中国卫生标准管理. 2022(18): 120-124 . 百度学术
12.	谭斌，王秀丽. 特利加压素联合生长抑素治疗肝硬化并发上消化道出血的临床效果及对血清GCG与NO水平的影响. 临床合理用药杂志. 2022(32): 68-70+74 . 百度学术
13.	陈斌，李菊花，卢晓霞. 奥美拉唑联合特利加压素对肝硬化上消化道出血患者血流动力学与血清学指标的影响. 现代医学与健康研究电子杂志. 2021(02): 120-122 . 百度学术
14.	李雅，唐奇远，赖长祥，黄嘉敏，伍婷，何清. 乙型肝炎病毒相关肝细胞癌患者并发上消化道出血的影响因素. 中国肝脏病杂志(电子版). 2021(03): 56-61 . 百度学术
15.	刘洋，石小倩. 生长抑素联合奥美拉唑治疗非静脉曲张性上消化道出血的临床效果. 临床合理用药杂志. 2021(29): 65-67 . 百度学术
16.	黄洁，童轶. 特利加压素联合奥美拉唑治疗肝硬化上消化道出血的临床研究及止血效果分析. 中国社区医师. 2021(32): 39-40 . 百度学术
17.	范文俊，吴霞. 特利加压素联合普奈洛尔对肝硬化上消化道出血患者血压及血流动力学指标的影响. 中国当代医药. 2021(35): 54-56+60 . 百度学术
18.	杨雅娟，李静女，乔冠恩. 内镜下食管静脉曲张套扎术联合生长抑素治疗肝硬化食管静脉曲张出血的疗效. 现代消化及介入诊疗. 2021(12): 1573-1575 . 百度学术