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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Issue 7
Jul.  2018
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Article Contents

Current status of research on primary and secondary risk factors for esophagogastric variceal rebleeding in patients with liver cirrhosis

DOI: 10.3969/j.issn.1001-5256.2018.07.041
  • Received Date: 2018-01-10
  • Published Date: 2018-07-20
  • There are various risk factors for esophagogastric variceal bleeding ( EVB) in patients with liver cirrhosis, such as portal hypertension, thrombosis and blood coagulation in the ruptured blood vessel, sclerotic region or number of ligation points, internal environment, degree of risk of malnutrition, Child-Pugh class, the extent of varices, red color sign, severity of bleeding, and diameter of the portal vein.This article reviews the current status of research on risk factors for EVB in patients with liver cirrhosis and classifies such factors into primary and secondary risk factors, and it is pointed out that portal venous pressure, ability of rapid thrombosis in the ruptured blood vessel, presence or absence of emergency treatment, internal environment, degree of risk of malnutrition, and hepatic functional reserve are predominant risk factors for esophagogastric variceal rebleeding in patients with liver cirrhosis.

     

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  • [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]TRIANTOS CK, NIKOLOPOULOU V, BURROUGHS AK.Review article:The therapeutic and prognostic benefit of portal pressure reduction in cirrhosis[J].Aliment Pharmacol Ther, 2008, 28 (8) :943-952.
    [3]TRIPODI A, PRIMIGNANI M, CHANTARANGKUL V, et al.Thrombin generation in patients with cirrhosis:The role of platelets[J].Hepatology, 2006, 44 (2) :440-445.
    [4]BENEDETO-STOJANOV D, NAGORNI A, MLADENOVIC'B, et al.Risk and causes of gastroesophageal bleeding in patients with liver cirrhosis[J].Vojnosanit Pregl, 2007, 64 (9) :585-589.
    [5]VILLA E, CAMMAC, MARIETTA M, et al.Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis[J].Gastroenterology, 2012, 143 (5) :1253-1260.
    [6]TRIPODI A, MANNUCCI PM.The coagulopathy of chronic liver disease[J].N Engl J Med, 2011, 365 (2) :147-156.
    [7]DAI C, LIU W X, JIANG M, et al.Endoscopic variceal ligation compared with endoscopic injection sclerotherapy for treatment of esophageal variceal hemorrhage:A meta-analysis[J].World J Gastroenterol, 2015, 21 (8) :2534-2541.
    [8]ZHOU JW, LIN YS, LIN XZ, et al.Endoscopic variceal ligation versus endoscopic variceal sclerotherapy in treatment of esophageal variceal bleeding:A meta-analysis[J].China J Endosc, 2017, 23 (1) :39-46. (in Chinese) 周江伟, 林叶素, 林细州, 等.内镜下套扎与硬化剂治疗食管静脉曲张破裂出血疗效的Meta分析[J].中国内镜杂志, 2017, 23 (1) :39-46.
    [9]XU L, JI F, XU QW, et al.Risk factors for predicting early variceal rebleeding after endoscopic variceal ligation[J].World J Gastroenterol, 2011, 17 (28) :3347-3352.
    [10]JIN Y, WANG X, ZHANG LJ, et al.Risk factors for early rebleeding after esophageal variceal ligation in patients with liver cirrhosis[J].J Clin Hepatol, 2017, 33 (11) :2147-2151. (in Chinese) 金燕, 王雪, 张玲娟, 等.肝硬化患者食管静脉曲张套扎术后早期再出血的危险因素分析[J].临床肝胆病杂志, 2017, 33 (11) :2147-2151.
    [11]LEE SW, LEE TY, CHANG CS.Independent factors associated with recurrent bleeding in cirrhotic patients with esophageal variceal hemorrhage[J].Dig Dis Sci, 2009, 54 (5) :1128-1134.
    [12]ZANG LN, SUN ZQ, LI WB, et al.Meta-analysis of risk factors of gastroesophageal varices rebleeding after therapeutic endoscopy[J].Chin J Hepatol, 2015, 23 (4) :275-280. (in Chinese) 臧立娜, 孙自勤, 李文波, 等.食管胃静脉曲张经内镜治疗后再出血危险因素的Meta分析[J].中华肝脏病杂志, 2015, 23 (4) :275-280.
    [13]WANG J, CHAI GJ, LIU YD.Formation of ulcer after esophageal variceal sclerotherapy and analysis of correlated factors[J].Chin J Gastroenterol Hepatol, 2008, 17 (12) :1010-1012. (in Chinese) 王娟, 柴国君, 刘迎娣.食管静脉曲张硬化治疗后溃疡的发生及相关因素分析[J].胃肠病学和肝病学杂志, 2008, 17 (12) :1010-1012.
    [14]SHI YC, SUN G, MA X, et al.Risk factors for predicting in-hospital rebleeding following endoscopic variceal sclerotherapy[J].Int J Clin Exp Med, 2017, 10 (5) :8262-8269.
    [15]KONG DR, XU JM.Selection and application of endoscopic treatments for gastroesophageal varices[J/CD].Chin J Gastrointestinal Endoscopy:Electronic Edition, 2016, 3 (4) :171-176. (in Chinese) 孔德润, 许建明.食管胃静脉曲张内镜治疗方法的选择与应用[J/CD].中华胃肠内镜电子杂志, 2016, 3 (4) :171-176.
    [16]ZHAN GQ, TAN HB, LI F, et al.Analysis of the influencing factors of the early rebleeding in cirrhotic patients with esophageal and gastric variceal bleeding[J].Chin J Clin Gastroenterol, 2011, 23 (5) :292-295. (in Chinese) 占国清, 谭华炳, 李芳, 等.肝硬化食管胃静脉曲张破裂出血早期再出血影响因素分析[J].临床消化病杂志, 2011, 23 (5) :292-295.
    [17]YE XD.Study on the impact of emergency treatment after liver cirrhosis esophagus varicosity burst hemorrhage on the early rebleeding[J].China Modern Med, 2015, 22 (16) :37-39, 42. (in Chinese) 叶向东.肝硬化食管静脉曲张破裂出血急诊治疗后早期再出血的影响因素分析[J].中国当代医药, 2015, 22 (16) :37-39, 42.
    [18]ALTAMIRANO J, AUGUSTIN S, MUNTANER L, et al.Predicting very early rebleeding after acute variceal bleeding based in classification and regression tree analysis (CRTA) [J].Rev Gastroenterol Mex, 2010, 75 (1) :12-21.
    [19]KRIGE JE, KOTZE UK, DISTILLER G, et al.Predictive factors for rebleeding and death in alcoholic cirrhotic patients with acute variceal bleeding:A multivariate analysis[J].World J Surg, 2009, 33 (10) :2127-2135.
    [20]SHENG JY, ZHANG XW.Interpretations of UK guidelines on the management of variceal haemorrhage in cirrhotic patients[J].Chin J Pract Surg, 2016, 36 (12) :1282-1287. (in Chinese) 盛基尧, 张学文.《英国肝硬化病人静脉曲张出血治疗指南》解读[J].中国实用外科杂志, 2016, 36 (12) :1282-1287.
    [21]HAN D, QI XS, YU Y, et al.An excerpt of portal hypertensive bleeding in cirrhosis:Risk stratification, diagnosis and management-2016 practice guidance by the American Association for the Study of Liver Diseases[J].J Clin Hepatol, 2017, 33 (3) :422-427. (in Chinese) 韩丹, 祁兴顺, 于洋, 等.《2016年美国肝病学会肝硬化门静脉高压出血的风险分层、诊断和管理实践指导》摘译[J].临床肝胆病杂志, 2017, 33 (3) :422-427.
    [22]TANG B, WANG HF.ESPEN guidelines on parenteral nutrition:Hepatology[J].Chin Hepatol, 2009, 14 (6) :479-482. (in Chinese) 汤勃, 王慧芬.欧洲肠内外营养学会2009年版肝病肠外营养指南要点介绍[J].肝脏, 2009, 14 (6) :479-482.
    [23]ZHANG HK, MENG XL, LI HL, et al.Current status of malnutrition and its association with prognosis in hospitalized patients with decompensated liver cirrhosis[J].J Clin Hepatol, 2016, 32 (6) :1100-1103. (in Chinese) 张辉凯, 孟祥林, 李海雷, 等.失代偿期肝硬化住院患者营养不良情况及其与预后的关系[J].临床肝胆病杂志, 2016, 32 (6) :1100-1103.
    [24]DONG GL, CHEN YJ, FU Q, et al.Clinical guidelines on parenteral and enteral nutrition by Chinese Society of Parenteral and Enteral Nutrition, Chinese Medical Association, Part 6 nutritional support[C]//Collection of data from the Sub-Forum on“Overview and Advances in Nutritional Support”and the Founding Conference of Zhejiang Society of Parenteral and Enteral Nutrition, Zhejiang Medical Association.2007. (in Chinese) 董光龙, 陈鄢津, 傅强, 等.中华医学会肠外肠内营养学分会肠外肠内营养临床指南第六部分疾病营养支持[C]//“营养支持的概况与进展”分论坛暨浙江省医学会肠外肠内营养学分会成立大会资料汇编.2007.
    [25]DAI YH, GAO Q, WANG J.Risk factors for early rebleeding after endoscopic variceal ligation:A Meta-analysis[J].World Chin J Dig, 2013, 21 (28) :2987-2993. (in Chinese) 戴依慧, 高青, 王锦.食管静脉曲张套扎术后早期再出血的危险因素的Meta分析[J].世界华人消化杂志, 2013, 21 (28) :2987-2993.
    [26]WANG F, BU GK, SHEN SR, et al.Influence of endoscopic variceal ligation on liver function and risk factors of rebleeding[J].J Cent South Univ:Med Sci, 2013, 38 (5) :521-525. (in Chinese) 王芬, 步光奎, 沈守荣, 等.食管静脉曲张套扎术对肝功能的影响及术后再出血的危险因素分析[J].中南大学学报:医学版, 2013, 38 (5) :521-525.
    [27]ZHOU JN, WEI Z, SUN ZQ.Risk factors for early rebleeding after esophageal variceal ligation in patients with liver cirrhosis[J].Chin J Hepatol, 2016, 24 (7) :486-492. (in Chinese) 周嘉宁, 魏志, 孙自勤.肝硬化食管静脉曲张套扎后早期再出血相关危险因素的多中心研究[J].中华肝脏病杂志, 2016, 24 (7) :486-492.
    [28]RUDLER M, BUREAU C, CARBONELL N, et al.Recalibrated MELD and hepatic encephalopathy are prognostic factors in cirrhotic patients with acute variceal bleeding[J].Liver Int, 2018, 38 (3) :469-476.
    [29]RADISAVLJEVIC'M, BJELAKOVIC'G, JOVIC'J, et al.Creatininemodified Child-Turcotte-Pugh score is a good predictor of a shortterm survival in patients with bleeding from esophageal varices[J].Vojnosanit Pregl, 2017, 74 (1) :13-18.
    [30]ASRANI SK, KAMATH PS.Prediction of early mortality after variceal bleeding:Score one more for MELD[J].Gastroenterology, 2014, 146 (2) :337-339.
    [31]RAMANATHAN S, KHANDELWAL N, KALRA N, et al.Correlation of HVPG level with ctp score, MELD Score, ascites, size of varices, and etiology in cirrhotic patients[J].Saudi J Gastroenterol, 2016, 22 (2) :109-115.
    [32]HUNTER SS, HAMDY S.Predictors of early re-bleeding and mortality after acute variceal haemorrhage[J].Arab J Gastroenterol, 2013, 14 (2) :63-67.
    [33]YANG H, LIU YX, LI P, et al.Analysis of risk factors for early rebleeding from esophageal and gastric varices in patients with liver cirrhosis[J].J Clin Heptal, 2014, 30 (6) :540-542. (in Chinese) 杨花, 刘云霞, 李鹏, 等.肝硬化患者食管胃底静脉曲张破裂早期再出血的危险因素分析[J].临床肝胆病杂志, 2014, 30 (6) :540-542.
    [34]WU LM, WU JM, LIU Y, et al.Risk factors for early rebleeding in cirrhotic patients with esophageal variceal bleeding[J].J Pract Med, 2009, 25 (22) :3803-3805. (in Chinese) 吴利敏, 吴金明, 刘扬, 等.肝硬化食管静脉曲张破裂出血早期再出血的危险因素分析[J].实用医学杂志, 2009, 25 (22) :3803-3805.
    [35]YANG MT, CHEN HS, LEE HC, et al.Risk factors and survival of early bleeding after esophageal variceal ligation[J].Hepatogastroenterology, 2007, 54 (78) :1705-1709.
    [36]MOSTAFA EF, MOHAMMAD AN.Incidence and predictors of rebleeding after band ligation of oesophageal varices[J].Arab J Gastroenterol, 2014, 15 (3-4) :135-141.
    [37]AMITRANO L, GUARDASCIONE MA, MANGUSO F, et al.The effectiveness of current acute variceal bleed treatments in unselected cirrhotic patients:Refining short-term prognosis and risk factors[J].Am J Gastroenterol, 2012, 107 (12) :1872-1878.
    [38]HOU MC, LIN HC, LIU TT, et al.Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage:A randomized trial[J].Hepatology, 2004, 39 (3) :746-753.
    [39]YANG Y, FAN YH, FANG L, et al.Risk factors of early rebleeding after endoscopic treatment of gastroesophageal varices[J].J Clin Hepatol, 2013, 29 (3) :178-183. (in Chinese) 杨艳, 樊艳华, 房龙, 等.内镜治疗食管胃静脉曲张早期再出血的影响因素分析[J].临床肝胆病杂志, 2013, 29 (3) :178-183.
    [40]GU C, LI L, WANG J, et al.Study on efficacy of endoscopic ligation therapy for esophageal varices and risk factors for postoperative rebleeding[J].J Clin Hepatol, 2014, 30 (12) :1279-1282. (in Chinese) 古川, 李璐, 王军, 等.内镜下套扎术治疗肝硬化食管静脉曲张的疗效及术后再出血的危险因素分析[J].临床肝胆病杂志, 2014, 30 (12) :1279-1282.
    [41]TIAN NN, XIANG HL, LYU HM, et al.Factors affecting rebleeding after injection of cyanoacrylate for gastric varices[J].World Chin J Dig, 2013, 21 (10) :908-914. (in Chinese) 田念念, 向慧玲, 吕洪敏, 等.组织黏合剂治疗胃底静脉曲张术后再出血的相关因素[J].世界华人消化杂志, 2013, 21 (10) :908-914.
    [42]BIAN F, LI YL, LI FX, et al.Risk factors affecting re-bleeding after endoscopic injection of cyanoacrylate for gastric varices[J/CD].Chin J Gastrointestinal Endoscopy:Electronic Edition, 2017, 4 (1) :14-18. (in Chinese) 边芬, 李仰龙, 李访贤, 等.内镜下组织胶治疗胃静脉曲张术后再出血的风险因素分析[J/CD].中华胃肠内镜电子杂志, 2017, 4 (1) :14-18.
    [43]MAJID S, AZAM Z, SHAH HA, et al.Factors determining the clinical outcome of acute variceal bleed in cirrhotic patients[J].Indian J Gastroenterol, 2009, 28 (3) :93-95.
    [44]WANG XL, HAN ZY, FU XH, et al.Risk factors for rebleeding in the early stage of hospitalization in cirrhotic patients with esophageal variceal bleeding and related nursing strategies (1) [J].P Clin Med, 2015, 24 (1) :51-52. (in Chinese) 王香莉, 韩子岩, 付晓红, 等.肝硬化食管静脉曲张破裂住院早期再出血危险因素分析及护理对策[1][J].临床医药实践, 2015, 24 (1) :51-52.
    [45]LI QN, NIE YQ.Risk factors for recent rebleeding after endoscopic therapy for cirrhotic esophageal varice[J].Mod Digest Interv, 2009, 14 (4) :207-209. (in Chinese) 黎庆宁, 聂玉强.内镜治疗肝硬化食管静脉曲张后近期再出血的危险因素分析[J].现代消化及介入诊疗, 2009, 14 (4) :207-209.
    [46]CHO H, NAGATA N, SHIMBO T, et al.Recurrence and prognosis of patients emergently hospitalized for acute esophageal variceal bleeding:A long-term cohort study[J].Hepatol Res, 2016, 46 (13) :1338-1346.
    [47]MA YM, LIANG YF, SHI SL, et al.The correlative research of dynamic changes of the serum C-reactive protein and the rehaemorrhagia after the esophageal varices band ligation[J].Shanxi Med J, 2016, 45 (11) :1250-1252. (in Chinese) 马娅梅, 梁艳芳, 石胜利, 等.C反应蛋白动态变化与食管静脉曲张套扎术后再出血的相关性研究[J].山西医药杂志, 2016, 45 (11) :1250-1252.
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