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

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.