Takeshita Eiji, Matsui Hidetaka, Shibata Naozumi, Furukawa Shinya, Yokota Tomoyuki, Murakami Hidehiro, Ikeda Yoshiou, Hiasa Yoichi, Matsuura Bunzo, Michitaka Kojiro, Onji Morikazu
Third Department of Internal Medicine, Ehime University School of Medicine, 791-0295, Ehime, Shigenobu-Cho, Japan.
J Gastroenterol. 2004 Nov;39(11):1085-9. doi: 10.1007/s00535-004-1447-1.
Variceal bleeding is a common, life-threatening complication of primary biliary cirrhosis (PBC). Recently, several reports have suggested that the existence of esophageal varices in patients with PBC is a significant factor in the assessment of disease prognosis. However, there have been no reports on the recurrence of esophageal varices following treatment in patients with PBC. In this study, we investigated the recurrence of esophageal varices in PBC patients and attempted to identify predictive factors for the recurrence of esophageal varices.
Between April 1993 and August 2003, 138 patients with esophageal varices who had been treated by endoscopic variceal ligation (EVL; 96 men and 42 women; age, 33-83 years; mean, 62.6 +/- 10.1 years), were enrolled in the present study. The diagnosis of esophageal varices was made by upper gastrointestinal endoscopy, and the varices were graded according to the criteria of the Japanese Research Society for Portal Hypertension. The relationship between the recurrence of esophageal varices and factors such as biochemical and hematological parameters, as well as the etiology of the liver disease, was analyzed using the Kaplan-Meier method and the multivariate Weibull regression model.
PBC patients had an earlier recurrence of esophageal varices compared to non-PBC patients, and two factors, prothrombin time and etiology (PBC/non-PBC), were indicative of significantly earlier recurrence of esophageal varices.
We should be extra careful in the follow-up of patients with PBC after therapy for esophageal varices.
静脉曲张出血是原发性胆汁性肝硬化（PBC）常见的、危及生命的并发症。最近，一些报告表明，PBC患者食管静脉曲张的存在是评估疾病预后的一个重要因素。然而，尚无关于PBC患者治疗后食管静脉曲张复发情况的报告。在本研究中，我们调查了PBC患者食管静脉曲张的复发情况，并试图确定食管静脉曲张复发的预测因素。
1993年4月至2003年8月期间，138例接受内镜下静脉曲张结扎术（EVL）治疗的食管静脉曲张患者（96例男性，42例女性；年龄33 - 83岁，平均62.6±10.1岁）纳入本研究。食管静脉曲张的诊断通过上消化道内镜检查做出，静脉曲张根据日本门静脉高压研究学会的标准进行分级。使用Kaplan-Meier法和多变量Weibull回归模型分析食管静脉曲张复发与生化和血液学参数等因素以及肝病病因之间的关系。
与非PBC患者相比，PBC患者食管静脉曲张复发更早，凝血酶原时间和病因（PBC/非PBC）这两个因素表明食管静脉曲张复发明显更早。
对于食管静脉曲张治疗后的PBC患者，我们在随访中应格外小心。
