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

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χ^2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,早期再出血率分别为25%、27.5%、16.7%,迟发性再出血率分别为16.7%,27.3%、40%,以上指标3组间差异均无统计学意义(P值均>0.05);联合治疗组与生长抑素组并发AKI患者的治疗改善率分别为100%、50%,差异无统计学意义(P=0.429);3组患者的半年累积生存率差异无统计学意义(部分分布风险比=1.40,95%CI:0.60~3.27,P=0.436)。结论特利加压素联合生长抑素与单用生长抑素、单用特利加压素均可有效控制肝硬化EVB,3种治疗方案治疗效果无明显差异;与单用生长抑素相比,联合应用特利加压素对改善AKI方面具有潜在优势。

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 time1.00(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.