Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
J Hepatol. 2012 May;56(5):1025-1032. doi: 10.1016/j.jhep.2011.12.021. Epub 2012 Jan 17.
BACKGROUND & AIMS: Gastric variceal obturation (GVO) therapy is the current treatment of choice for gastric variceal bleeding (GVB). However, the efficacy of non-selective β-blockers (NSBB) in the secondary prevention of GVB is still debatable. This study aimed at evaluating the efficacy of additional NSBB to repeated GVO in the secondary prevention of GVB.
From April 2007 to March 2011, 95 patients with GVB after primary hemostasis using GVO were enrolled. Repeated GVO were performed until GV eradication. Forty-eight and 47 patients were randomized into the GVO alone group (Group A) and the GVO+NSBB group (Group B), respectively. Primary outcomes in terms of re-bleeding and overall survival were analyzed by multivariate analysis.
After a mean follow-up of 18.10 months in group A, 26 patients bled and 20 died. In group B, 22 patients bled and 22 died after a mean follow-up of 20.29 months. The overall re-bleeding and survival rates analyzed by the Kaplan-Meier method were not different between the two groups (p=0.336 and 0.936, respectively). The model of end-stage liver disease (MELD) score and main portal vein thrombosis (MPT) were independent determinants of re-bleeding while MPT and re-bleeding were independent factors of mortality by time-dependent Cox-regression model. Asthenia was the most common adverse event and was higher in group B (p<0.001).
Adding NSBB therapy to repeated GVO provides no benefit for the secondary prevention of bleeding and mortality in patients with GVB.
胃静脉曲张闭塞（GVO）治疗是目前胃静脉曲张出血（GVB）的首选治疗方法。然而，非选择性β受体阻滞剂（NSBB）在 GVB 二级预防中的疗效仍存在争议。本研究旨在评估在 GVB 二级预防中，重复 GVO 加用 NSBB 的疗效。
2007 年 4 月至 2011 年 3 月，95 例 GVB 患者在初次止血后采用 GVO 治疗。反复进行 GVO 直至 GV 消除。48 例和 47 例患者随机分为 GVO 组（A 组）和 GVO+NSBB 组（B 组）。通过多变量分析评估再出血和总体生存的主要结局。
A 组平均随访 18.10 个月，26 例患者出血，20 例患者死亡。B 组平均随访 20.29 个月，22 例患者出血，22 例患者死亡。Kaplan-Meier 法分析的总体再出血和生存率在两组之间无差异（p=0.336 和 0.936）。终末期肝病模型（MELD）评分和主门静脉血栓形成（MPT）是再出血的独立决定因素，而 MPT 和再出血是时间依赖性 Cox 回归模型中死亡率的独立因素。乏力是最常见的不良反应，B 组发生率更高（p<0.001）。
在重复 GVO 治疗中加用 NSBB 治疗对 GVB 患者的出血和死亡率的二级预防没有益处。
