中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

Clinical features of rebleeding after secondary prevention for esophagogastric variceal bleeding in cirrhotic portal hypertension

DOI: 10.3969/j.issn.1001-5256.2020.08.014
Research funding:

 

  • Published Date: 2020-08-20
  • ObjectiveTo investigate the clinical manifestations, emergency endoscopic diagnosis and treatment, and prognosis of rebleeding after different secondary prevention measures for esophagogastric variceal bleeding in cirrhotic portal hypertension. MethodsA retrospective analysis was performed for the clinical data of 254 patients with rebleeding after secondary prevention (endoscopic therapy, surgical treatment, or interventional prevention) for esophagogastric variceal bleeding who underwent emergency endoscopic diagnosis and treatment in The Fifth Medical Center of Chinese PLA General Hospital from January 2018 to April 2019, and 419 patients who received medication alone for the prevention of rebleeding during the same period of time were enrolled as controls. Clinical features were observed and compared between groups. An analysis of variance was used for comparison of normally distributed continuous data between groups, and the Kruskal-Wallis H test was used for comparison of continuous data with heterogeneity of variance between groups. The least significant difference Bonferroni test was used for further comparison between two groups. The chi-square test  was used for comparison of categorical data between groups. ResultsAmong the 254 patients with rebleeding after secondary prevention, 144 (56.69%) received endoscopic prevention, 40 (15.75%) received surgical prevention, 33 (12.99%) received interventional prevention, and 37(14.57%) received prevention with endoscopy combined with other prevention measures. As for the time from last prevention to bleeding, 57.50% in the surgical prevention group had a time of more than 5 years, and 69.70% in the interventional prevention group experienced bleeding within 1 year after transjugular intrahepatic portosystemic shunt; 40.28% in the endoscopic prevention group and 35.14% in the combined prevention group experienced rebleeding within 1 year after prevention ended. During rebleeding, the interventional prevention group and the combined prevention group had a significantly higher incidence rate of hepatic encephalopathy than the other groups (all P<0.001), and the interventional prevention group had significantly better controlled ascites than the other groups (all P<0.05). There were significant differences in various clinical indices between these groups during rebleeding (all P<0.001), and the endoscopic prevention group had significantly higher levels of hemoglobin and albumin than the surgical prevention group (P<0.001 and P=0.001) and the medication prevention group (P=0.001 and P<0.001). The surgical prevention group had a significantly higher platelet count than the interventional prevention group (P=0.037), the combined prevention group (P<0.001), and the medication prevention group (P=0.012). The medication prevention group had a significantly higher level of bilirubin than the endoscopic prevention group (P=0.037), the interventional prevention group (P=0.025), and the combined prevention group (P<0.001); the surgical prevention group had a significantly higher level of creatinine than the other four groups (all P<0.05); the combined prevention group had significantly better coagulation parameters prothrombin time and international normalized ratio than the medication prevention group (both P=0.002). The medication prevention group had a significantly higher proportion of patients with active bleeding than the endoscopic prevention group (P<0.001), the interventional prevention group (P=0.004), and the combined prevention group (P=0.008). The surgical prevention group and the medication prevention group had a significantly higher proportion of patients with esophageal variceal bleeding than the other groups (all P<0.05), and the interventional prevention group had a significantly higher proportion of patients with peptic ulcer and bleeding than the other four groups (all P<0.05). The medication prevention group had significantly higher dissatisfaction rate and failure rate of endoscopic treatment than the endoscopic prevention group (P<0.001), the interventional prevention group (P=0.007), and the combined prevention group (P<0.001). The medication prevention group had significantly higher rebleeding rate and mortality rate within 42 days than the other four groups (all P<0.05). Conclusion Compared with medication prevention alone, interventional prevention, endoscopic prevention, or combined secondary prevention can significantly alleviate the degree of esophagogastric variceal rebleeding, improve the hemostatic rate of emergency endoscopy, and significantly reduce rebleeding rate and mortality rate within 42 days. The clinical features of rebleeding after different secondary prevention measures should be considered to perform individualized treatment of patients with rebleeding after secondary prevention for esophagogastric variceal bleeding.

     

  • [1]GARCA-PAGN JC,REVERTER E,ABRALDES JG,et al.Acute variceal bleeding[J].Semin Respir Crit Care Med,2012,33(1):46-54.
    [2]Chinese Society of Hepatology,Chinese Medical Association;Chinese Society of Gastroenteroloty,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.
    [3]Portal Hypertension Group,Chinese Society of Surgery,Chinese Medical Association.Expert consensus on the diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension[J].Chin J Pract Surg,2015,35 (10):1086-1090.(in Chinese)中华医学会外科学分会门静脉高压症学组.肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2015)[J].中国实用外科杂志,2015,35(10):1086-1090.
    [4]Interventional Group,Chinese Society of Radiology,Chinese Medical Association.Expert consensus on transjugular intrahepatic portosystemic shunt[J].J Clin Hepatol,2017,33 (7):1218-1228.(in Chinese)中华医学会放射学分会介入学组.经颈静脉肝内门体分流术专家共识[J].临床肝胆病杂志,2017,33(7):1218-1228.
    [5]DENG H,QI XS,GUO XZ.UK guidelines on the management of variceal haemorrhage in cirrhotic patients (2015):An excerpt of recommendations[J].J Clin Hepatol,2015,31 (6):852-854.(in Chinese)邓晗,祁兴顺,郭晓钟.《2015年英国肝硬化静脉曲张出血防治指南》摘译[J].临床肝胆病杂志,2015,31(6):852-854.
    [6]CHENG LF,LI CZ.A multi-center survey of esophagogastic variceal bleeding in China[J].J Clin Hepatol,2012,28 (6):462-464.(in Chinese)程留芳,李长政.全国多中心食管胃静脉曲张出血调查[J].临床肝胆病杂志,2012,28(6):462-464.
    [7]Chinese Society of Hepatology,Chinese Medical Association.Chinese guidelines on the management of liver cirrhosis[J].JClin Hepatol,2019,35(11):2408-2425.(in Chinese)中华医学会肝病学分会.肝硬化诊治指南[J].临床肝胆病杂志,2019,35(11):2408-2425.
    [8] Chinese Society of Spleen and Portal Hypertension Surgery,Chinese Society of Surgery,Chinese Medical Association.Expert consensus on diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension (2019edition)[J].Chin J Dig Surg,2019,18 (12):1087-1093.(in Chinese)中华医学会外科学分会脾及门静脉高压外科学组.肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版)[J].中华消化外科杂志,2019,18(12):1087-1093.
    [9]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.
    [10]CHEN LG,YE ZS,REN JL,et al.The short-term effect and saftety analysis of endoscopic esophageal variceal ligation[J].Jilin Med J,2014,35(34):7586-7588.(in Chinese)陈立刚,叶震世,任建林,等.内镜食管静脉曲张套扎术的短期疗效和安全性分析[J].吉林医学,2014,35(34):7586-7588.
    [11]CAO YJ,PAN YM,BAO SH,et al.Analysis of prognostic factors of portal hypertension treated with devascularization[J].Chin J Surg,2016,54(6):434-438.(in Chinese)曹亚娟,潘一明,包善华,等.断流术治疗门静脉高压症的预后影响因素分析[J].中华外科杂志,2016,54(6):434-438.
    [12]ZENG DB,DI L,DING J,et al.Clinical efficacy of devascularization in treatment of esophageal and gastric varices in cirrhosis patients with portal hypertension[J/CD].Chin J Hepat Surg:Electronic Edition,2019,8(4):306-310.(in Chinese)曾道炳,邸亮,丁兢,等.断流术治疗肝硬化门静脉高压症食管胃静脉曲张疗效[J/CD].中华肝脏外科手术学电子杂志,2019,8(4):306-310.
    [13]LING WM,LI HF,HUANG QL.Effect of splenectomy combined with pericardial vascular dissection on liver function and hemodynamics in patients with cirrhosis of the portal vein[J/CD].Chin Arch Gen Surg (Electronic Edition),2018,12(2):115-119.(in Chinese)凌伟明,李鸿飞,黄庆录.脾切除联合贲门周围血管离断术对肝硬化门静脉高压症患者肝功能及血流动力学的影响[J/CD].中华普通外科学文献(电子版),2018,12(2):115-119.
    [14]TAN J,ZHOU M,DENG QZ,et al.Transjugular intrahepatic portosystemic shunt (TIPS) for gastroesophageal variceal bleeding in cirrhotic patients with portal hypertension:A 2-year clinical outcomes surveillance study[J].Zhejiang Med J,2019,41(11):1138-1142.(in Chinese)谭俊,周密,邓勤智,等.经颈静脉肝内门体分流术治疗肝硬化门静脉高压症并发食管胃底静脉曲张破裂出血2年生存分析[J].浙江医学,2019,41(11):1138-1142.
  • Relative Articles

    [1]Jinqiu YANG, Wenxia ZHAO, Cheng ZHOU, Tong LIU. Risk factors for the development of advanced liver fibrosis in nonalcoholic fatty liver disease and establishment of a nomogram model[J]. Journal of Clinical Hepatology, 2024, 40(8): 1579-1584. doi: 10.12449/JCH240812
    [2]Shunxiao ZHANG, Sheng ZHANG, Yan ZHANG, Yuanyuan LI, Yue CHEN, Mingyu SUN. Influencing factors for nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus[J]. Journal of Clinical Hepatology, 2023, 39(5): 1081-1088. doi: 10.3969/j.issn.1001-5256.2023.05.013
    [3]Yujuan ZHANG, Xiqiao ZHOU. Research advances in lean nonalcoholic fatty liver disease[J]. Journal of Clinical Hepatology, 2023, 39(12): 2914-2919. doi: 10.3969/j.issn.1001-5256.2023.12.024
    [4]Sarula BAO, Xiaoxu DU, Hongyan GE. Value of Helicobacter pylori infection combined with traditional risk factors in predicting the risk of metabolic associated fatty liver disease[J]. Journal of Clinical Hepatology, 2023, 39(6): 1318-1324. doi: 10.3969/j.issn.1001-5256.2023.06.011
    [5]Yifu YUAN, Qin CAO, Yuanye JIANG. Association of dietary behavior with nonalcoholic fatty liver disease[J]. Journal of Clinical Hepatology, 2023, 39(2): 401-407. doi: 10.3969/j.issn.1001-5256.2023.02.024
    [6]Cheng ZHOU, Ran JIA, Jingjing WEI, Chenlu ZHAO, Dongfang SHANG, Wenxia ZHAO. Risk factors for cognitive impairment associated with nonalcoholic fatty liver disease[J]. Journal of Clinical Hepatology, 2022, 38(11): 2592-2595. doi: 10.3969/j.issn.1001-5256.2022.11.031
    [7]Ling QING, Weiqiang HUANG, Xiaohe LI, Feng CHEN, Yingxia LIU. Efficacy of antiviral therapy for chronic hepatitis B with nonalcoholic fatty liver disease[J]. Journal of Clinical Hepatology, 2021, 37(9): 2075-2080. doi: 10.3969/j.issn.1001-5256.2021.09.015
    [8]He CHEN, Juanjuan FU, Li LI, Guangde YANG, Xiucheng PAN. Influencing factors for low-level viremia in chronic hepatitis B patients treated with long-term entecavir antiviral therapy[J]. Journal of Clinical Hepatology, 2021, 37(3): 556-559. doi: 10.3969/j.issn.1001-5256.2021.03.011
    [9]Yangyang LI, Zhengyuan XIE. Advances in the etiology and treatment of non-obese nonalcoholic fatty liver disease[J]. Journal of Clinical Hepatology, 2021, 37(2): 452-457. doi: 10.3969/j.issn.1001-5256.2021.02.043
    [10]Tian TIAN, Wenwei HU, Xue LI, Jie WU, Dan ZHANG, Changzheng LI. Association between thyroxine level and nonalcoholic fatty liver disease[J]. Journal of Clinical Hepatology, 2021, 37(10): 2357-2363. doi: 10.3969/j.issn.1001-5256.2021.10.020
    [11]Cong TONG, Yanian LI, Da GU, Xiang'an ZHAO, Xiaoxing XIANG. The association between obesity measurement indices and nonalcoholic fatty liver disease[J]. Journal of Clinical Hepatology, 2021, 37(10): 2465-2468. doi: 10.3969/j.issn.1001-5256.2021.10.044
    [12]Dongxu WANG, Chuan XING, Bo LYU, Han ZHAO, Bing HE. Risk factors for polycystic ovary syndrome with nonalcoholic fatty liver disease[J]. Journal of Clinical Hepatology, 2021, 37(10): 2474-2477. doi: 10.3969/j.issn.1001-5256.2021.10.046
    [13]Tian Tian, Hu WenWei, Li Xue, Li Ji, Zhang Dan, Li ZhangZheng. Metabolic characteristics of nonalcoholic fatty liver disease and related risk factors in non-obese population[J]. Journal of Clinical Hepatology, 2020, 36(6): 1310-1313. doi: 10.3969/j.issn.1001-5256.2020.06.024
    [14]Yao ChengZi, Liu ZiZhen, Feng Gong, He Na, Mi Man. Risk factors for childhood nonalcoholic fatty liver disease and related prevention and management strategies[J]. Journal of Clinical Hepatology, 2020, 36(7): 1623-1626. doi: 10.3969/j.issn.1001-5256.2020.07.038
    [15]Yao ChengZi, Feng Gong, Yu WenSi, Du Huan, Mi Man. Risk factors for the development and progression of nonalcoholic fatty liver disease[J]. Journal of Clinical Hepatology, 2020, 36(2): 433-436. doi: 10.3969/j.issn.1001-5256.2020.02.044
    [16]Feng Gong, He Na, Mi Man, Li XuePing, Liu ManLing, Fan LiPing, Niu ChunYan. Risk factors for the coexistence of inflammatory bowel disease and nonalcoholic fatty liver disease: A Meta-analysis[J]. Journal of Clinical Hepatology, 2019, 35(4): 835-839. doi: 10.3969/j.issn.1001-5256.2019.04.025
    [17]Huang ZhiPeng, Jiang JianJia, Huang ZiCheng, Guo GuiYuan, Zhou APei, Liu XiaoQiang. Risk factors of nonalcoholic fatty liver disease with a normal visceral adipose tissue area[J]. Journal of Clinical Hepatology, 2019, 35(5): 1061-1064. doi: 10.3969/j.issn.1001-5256.2019.05.025
    [18]Ding YuPing, Li Hai, Zhang Wen, Xia ShiHai, Bi Xun. Epidemiological characteristics of nonalcoholic fatty liver disease with elevated alanine aminotransferase and related risk factors[J]. Journal of Clinical Hepatology, 2017, 33(12): 2355-2360. doi: 10.3969/j.issn.1001-5256.2017.12.020
    [19]Zhang YiNing, Du HongWei, Liu YanJun, Wang ChaoXia. The diagnosis and risk factors for evaluation of nonalcoholic fatty liver disease in children and adolescents[J]. Journal of Clinical Hepatology, 2011, 27(7): 690-693.
    [20]Chen Xi, Liang Bing, Wang YiGe, Fan XiaoHong. The Analysis of The efficacy and risk factors in obesity with non-alcoholic fatty liver disease subjects treated with orlistat.[J]. Journal of Clinical Hepatology, 2006, 22(2): 123-124.
  • Cited by

    Periodical cited type(17)

    1. 杨文帅,王立坤,董聪慧,武永萍,石栓柱. 瞬时弹性成像技术联合血清游离脂肪酸对非酒精性脂肪性肝病的诊断价值. 转化医学杂志. 2024(09): 1330-1335 .
    2. 崔会鹏,田昊宇,关琳,李异玲. 代谢相关性脂肪性肝病无创诊断方法研究进展. 胃肠病学和肝病学杂志. 2022(01): 99-103 .
    3. 凡军芳,胡静,耿旭,庄兰艮,时照明. 2型糖尿病患者肝脏受控衰减参数与血清25-羟维生素D的相关性. 中华全科医学. 2021(05): 794-797 .
    4. 陈雅洁,李昭贤,王洋,曹经琳,窦剑. 瞬时弹性成像技术在肝移植围手术期应用的研究进展. 中华器官移植杂志. 2021(08): 501-504 .
    5. 林俊红,林常青,翁娜,刘宴伟. 中年女性高血压体检者体质指数异常与脂肪肝发病率的相关性研究及护理干预. 全科护理. 2020(10): 1212-1214 .
    6. 张晓静,林淑珍,张志安,温美兰. FibroTouch技术在诊断非酒精性脂肪性肝病患者肝脂肪变程度中的应用. 临床医学. 2020(04): 79-80 .
    7. 李萍英,李娟,谢守珍,杨永耿,陆伦根. FibroTouch联合超声和CT检查诊断高原地区非酒精性脂肪性肝病临床应用研究. 实用肝脏病杂志. 2020(06): 817-820 .
    8. 李正鑫,陈洋溢,赵志敏,吕靖,陈高峰,刘成海. 基于肝脏病理学对慢性乙型肝炎肝硬化患者FibroTouch测量值的影响因素分析. 临床肝胆病杂志. 2019(02): 338-344 . 本站查看
    9. 陈中淑. 超声检查在诊断脂肪肝方面的临床应用价值. 当代医药论丛. 2019(10): 26-28 .
    10. 何义华,罗建君,文安怡,程志生,余志映,吴舒婷. 二至解酲汤治疗酒精性肝病临床研究. 中医学报. 2018(06): 1099-1102 .
    11. 何妙峰. 腹部B超对健康体检者脂肪肝筛查的价值分析. 深圳中西医结合杂志. 2018(10): 90-91 .
    12. 王晴晴,胡明芬,杨红洁,禹蔚琴,柏保利,匡小林,庄林. B超在慢性HBV携带者合并非酒精性脂肪性肝病诊断中的应用. 肝脏. 2018(08): 723-727 .
    13. 王新. 脂肪肝与病毒性肝炎B超鉴别诊断结果的对比研究. 心理月刊. 2018(04): 47-48 .
    14. 张志伟. 肝功能与血清学指标水平检验对脂肪肝的诊断价值分析. 中外医疗. 2018(34): 11-13 .
    15. 南胜天. CT及B超在脂肪肝临床诊断中应用的价值. 甘肃科技. 2017(07): 102-103 .
    16. 庄小芳,孙洁,王晓波,王燕,吴琦琦,王晓忠. 瞬时弹性成像技术诊断非酒精性脂肪性肝病的性能评估. 临床肝胆病杂志. 2017(12): 2366-2371 . 本站查看
    17. 杨杰,曹玉芝,徐永升,王雪,刘闯. 373例非酒精性脂肪性肝病FibroTouch检测临床观察. 中国实用医药. 2017(24): 33-34 .

    Other cited types(12)

  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Article Metrics

    Article views (1414) PDF downloads(195) Cited by(29)
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return