中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 9
Sep.  2021
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(9): 2087-2091

Risk factors for early rebleeding after endoscopic therapy for esophageal varices in cirrhotic patients

DOI: 10.3969/j.issn.1001-5256.2021.09.017
  • 1.

    Health Care Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

  • 2.

    Center of Hepatic and Digestive Diseases, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China

Research funding:

The State Key Projects Specialized on Infectious Diseases (2017ZX10203202-004);

The Digestive Medical Coordinated Development Center of Beijing Hospitals Authority (XXZ0801)

  • Received Date: 2021-05-16
  • Accepted Date: 2021-06-07
  • Published Date: 2021-09-20
    Abstract
  •   Objective  To investigate the risk factors for early rebleeding after endoscopic ligation or sclerotherapy for esophageal variceal bleeding in cirrhotic patients.  Methods  A retrospective analysis was performed for the clinical data of 153 cirrhotic patients with esophageal variceal bleeding who underwent endoscopic ligation or sclerotherapy in Beijing YouAn Hospital, Capital Medical University, from May 2017 to May 2019, and according to the presence or absence of rebleeding from 72 hours to 6 weeks after endoscopic therapy, the patients were divided into rebleeding group and non-rebleeding group. A logistic regression analysis was performed to investigate independent risk factors for early rebleeding. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups.  Results  Early rebleeding rate was 24.8% (38/153). Compared with the non-rebleeding group, the rebleeding group had a significantly lower albumin (Alb) and significantly higher activated partial thromboplastin time and prothrombin time (all P < 0.05), and there were also significant differences between the two groups in proportion of male sex, degree of varicose veins, red color sign, portal vein thrombosis, severity of ascites, and liver function grade (all P < 0.05). The multivariate logistic regression analysis showed that portal vein thrombosis (odds ratio [OR]=9.781, 95% confidence interval [CI]: 2.248-42.556, P=0.002), massive ascites (OR=6.195, 95%CI: 1.053-36.447, P=0.044), and Child-Pugh class C liver function (OR=6.434, 95%CI: 1.067-38.786, P=0.042) were independent risk factors for early rebleeding, while Alb (OR=0.806, 95%CI: 0.685-0.947, P=0.009) was a protective factor against early rebleeding.  Conclusion  Portal vein thrombosis, massive ascites, Child-Pugh C liver cirrhosis, and hypoproteinemia are independent risk factors for early rebleeding after endoscopic therapy in cirrhotic patients with esophageal variceal bleeding, which should be taken seriously in clinical practice.

     

    • FullText(HTML)
  • loading
    • References(18)
  • [1]
    CERINI F, GONZALEZ JM, TORRES F, et al. Impact of anticoagulation on upper-gastrointestinal bleeding in cirrhosis A retrospective multicenter study[J]. Hepatology, 2015, 62(2): 575-583. DOI: 10.1002/hep.27783.
    [2]
    TOSHIKUNI N, TAKUMA Y, TSUTSUMI M. Management of gastroesophageal varices in cirrhotic patients: Current status and future directions[J]. Ann Hepatol, 2016, 15(3): 314-25. DOI: 10.5604/16652681.1198800.
    [3]
    LO GH. Endoscopic treatments for portal hypertension[J]. Hepatol Int, 2018, 12(Suppl 1): 91-101. DOI: 10.1007/s12072-017-9828-8.
    [4]
    WANG J, ZHENG GZ. Factors related to esophageal variceal bleeding in patients with liver cirrhosis[J/CD]. Chin J Liver Dis(Electronic Version), 2019, 11(1): 42-46. DOI: 10.3969/j.issn.1674-7380.2019.01.008.

    王娟, 郑鸽之. 肝硬化食管静脉曲张破裂出血相关因素分析[J/CD]. 中国肝脏病杂志(电子版), 2019, 11(1): 42-46. DOI: 10.3969/j.issn.1674-7380.2019.01.008.
    [5]
    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 (2019 edition)[J]. Chin J Dig Surg, 2019, 18 (12): 1087-1093. DOI: 10.3760/cma.j.issn.1673-9752.2019.12.001.

    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. DOI: 10.3760/cma.j.issn.1673-9752.2019.12.001.
    [6]
    Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35(11): 2408-2425. DOI: 10.3969/j. issn.1001-5256.2019.11.006.

    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. DOI: 10.3969/j. issn.1001-5256.2019.11.006.
    [7]
    CHEN LL, HAN W. The current status of endoscopic treatment of esophagogastric variceal bleeding[J]. Int J Dig Dis, 2018, 38(5): 283-286. DOI: 10.3969/j. issn.1673-534X.2018.05.001.

    陈兰兰, 韩文. 门静脉高压食管胃底静脉曲张破裂出血内镜下治疗现状[J]. 国际消化病杂志, 2018, 38(5): 283-286. DOI: 10.3969/j. issn.1673-534X.2018.05.001.
    [8]
    Esophageal and Gastric Varices Group, Chinese Society of Endoscopy, Chinese Medical Association. Tentative guidelines for endoscopic diagnosis and treatment of varicosity and Variceal bleeding in digestive tract(2009)[J]. Chin J Dig Endosc, 2010, 27(1): 1-4. DOI: 10.3760/cma. j. issn.1007-5232.2010.01.001.

    中华医学会消化内镜学分会食管胃静脉曲张学组. 消化道静脉曲张及出血的内镜诊断和治疗规范试行方案(2009年)[J]. 中华消化内镜杂志, 2010, 27(1): 1-4. DOI: 10.3760/cma. j. issn.1007-5232.2010.01.001.
    [9]
    LU ZY, ZHONG NS. Internal Medicine[M]. 7th ed. Beijng: People 's Medical Publishing House, 2008: 453.

    陆再英, 钟南山. 内科学[M]. 第7版. 北京: 人民卫生出版社, 2008: 453.
    [10]
    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. DOI: 10.3969/j.issn.1672-5069.2016.05.036.

    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. DOI: 10.3969/j.issn.1672-5069.2016.05.036.
    [11]
    ZHANG QM, LIU H, CHANG ZW, et al. Progress in endoscopic and interventional therapy for secondary prevention of esophagogastric variceal bleeding[J]. J North China Univ Sci Technol (Health Sciences Edition), 2020, 22(3): 247-252. DOI: 10.19539/j.cnki.2095-2694.2020.03.016.

    张秋萌, 刘辉, 常紫薇, 等. 食管胃静脉曲张出血二级预防的内镜和介入治疗研究进展[J]. 华北理工大学学报(医学版), 2020, 22(3): 247-252. DOI: 10.19539/j.cnki.2095-2694.2020.03.016.
    [12]
    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. DOI: 10.3760/cma. j. issn.1007-3418.2016.07.002.

    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. DOI: 10.3760/cma. j. issn.1007-3418.2016.07.002.
    [13]
    WANG X, MEI XC, ZHANG N, et al. Effects of diabetes on rebleeding after endoscopic treatment in liver cirrhosis patients with esophageal varices[J]. Chin J Dig Endosc, 2020, 37(1): 33-37. DOI: 10.3760/cma. j. issn.1007-5232.2020.01.007.

    王曦, 梅雪灿, 张娜, 等. 糖尿病对肝硬化食管静脉曲张内镜治疗后再出血影响的临床研究[J]. 中华消化内镜杂志, 2020, 37(1): 33-37. DOI: 10.3760/cma. j. issn.1007-5232.2020.01.007.
    [14]
    FOUAD TR, ABDELSAMEEA E, ABDEL-RAZEK W et al. Upper gastrointestinal bleeding in Egyptian patients with cirrhosis: Post-therapeutic outcome and prognostic indicators[J]. J Gastroenterol Hepatol, 2019, 34(9): 1604-1610. DOI: 10.1111/jgh.14659.
    [15]
    SUN YN, LI P, DING HG, et al. Risk factors for early rebleeding after initial sclerotherapy for esophageal varices[J]. J Clin Hepatol, 2019, 35(1): 93-98. DOI: 10.3969/j.issn.1001-5256.2019.01.017.

    孙亚男, 李鹏, 丁惠国, 等. 食管静脉曲张首次硬化剂治疗后早期再出血的危险因素[J]. 临床肝胆病杂志, 2019, 35(1): 93-98. DOI: 10.3969/j.issn.1001-5256.2019.01.017.
    [16]
    倪猛, 张海洋. 内镜下套扎联合硬化剂注射治疗乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者疗效及其再出血危险因素分析[J]. 实用肝脏病杂志, 2018, 21(2): 241-244. DOI: 10.3969/j.issn.1672-5069.2018.02.021.
    [17]
    CUl CC, LI DD, LI CF, et al. Risk factors for early rebleeding after first-time endoscopic variceal ligation[J]. J Clin Hepatol, 2018, 34(7): 1445-1451. DOI: 10.3969/j.issn.1001-5256.2018.07.017.

    崔璨璨, 李丹丹, 李长锋, 等. 食管静脉曲张首次套扎术后早期再出血的危险因素分析[J]. 临床肝胆病杂志, 2018, 34(7): 1445-1451. DOI: 10.3969/j.issn.1001-5256.2018.07.017.
    [18]
    LOFFREDO L, PASTORI D, FARCOMENI A, et al. Effects of anticoagulants in patients with cirrhosis and portal vein thrombosis: A systematic review and meta-analysis[J]. Gastroenterology, 2017, 153(2): 480-487. DOI: 10.1053/j.gastro.2017.04.042.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 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

    Tables(2)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (791) PDF downloads(60) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return