食管静脉曲张结扎术联合普萘洛尔与单用普萘洛尔对食管静脉曲张出血进行一级预防的比较。
The comparison of esophageal variceal ligation plus propranolol versus propranolol alone for the primary prophylaxis of esophageal variceal bleeding.
作者信息
Je Dongmo, Paik Yong-Han, Gwak Geum-Youn, Choi Moon Seok, Lee Joon Hyeok, Koh Kwang Cheol, Paik Seung Woon, Yoo Byung Chul
机构信息
Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
出版信息
Clin Mol Hepatol. 2014 Sep;20(3):283-90. doi: 10.3350/cmh.2014.20.3.283. Epub 2014 Sep 25.
BACKGROUND/AIMS: To investigate the efficacy and longterm outcome of esophageal variceal ligation (EVL) plus propranolol in comparison with propranolol alone for the primary prophylaxis of esophageal variceal bleeding.
METHODS
A total of 504 patients were retrospectively enrolled in this study. 330 patients were in propranolol group (Gr1) and 174 patients were in EVL plus propranolol group (Gr2). The endpoints of this study were esophageal variceal bleeding and mortality. Association analyses were performed to evaluate bleeding and mortality between Gr1 and Gr2.
RESULTS
EVL was more applied in patients with high risk, such as large-sized varices (F2 or F3) or positive red color signs. Total 38 patients had bleeds, 32 in Gr1 and 6 in Gr2. The cumulative probability of bleeding at 120 months was 13% in Gr1 versus 4% in Gr2 (P=0.04). The predictive factors of variceal bleeding were red color signs (OR 2.962, P=0.007) and the method of propranolol plus EVL (OR 0.160, P=0.000). 20 patients died in Gr1 and 12 in Gr2. Mortality rates are similar in the two groups compared, 6.7% in Gr1 and 6.9% in Gr2. The cumulative probability of mortality at 120 months was not significantly different in the two groups (7% in Gr1, 12% in Gr2, P=0.798). The prognostic factors for mortality were age over 50 (OR 5.496, P=0.002), Child-Pugh class B (OR 3.979, P=0.001), and Child-Pugh class C (OR 10.861, P=0.000).
CONCLUSIONS
EVL plus propranolol is more effective than propranolol alone in the prevention of the first variceal bleeding in patients with liver cirrhosis.
背景/目的：比较食管静脉曲张结扎术（EVL）联合普萘洛尔与单用普萘洛尔对食管静脉曲张出血进行一级预防的疗效和长期预后。
方法
本研究共回顾性纳入504例患者。普萘洛尔组（第1组）330例患者，EVL联合普萘洛尔组（第2组）174例患者。本研究的终点为食管静脉曲张出血和死亡率。进行关联分析以评估第1组和第2组之间的出血情况和死亡率。
结果
EVL更多应用于高风险患者，如大尺寸静脉曲张（F2或F3）或红色征阳性患者。共有38例患者发生出血，第1组32例，第2组6例。120个月时出血的累积概率在第1组为13%，在第2组为4%（P = 0.04）。静脉曲张出血的预测因素为红色征（比值比2.962，P = 0.007）和普萘洛尔联合EVL的方法（比值比0.160，P = 0.000）。第1组20例患者死亡，第2组12例患者死亡。两组比较死亡率相似，第1组为6.7%，第2组为6.9%。两组120个月时的累积死亡概率无显著差异（第1组为7%，第2组为12%，P = 0.798）。死亡的预后因素为年龄超过50岁（比值比5.496，P = 0.002）、Child-Pugh B级（比值比3.979，P = 0.001）和Child-Pugh C级（比值比10.861，P = 0.000）。
结论
在预防肝硬化患者首次静脉曲张出血方面，EVL联合普萘洛尔比单用普萘洛尔更有效。
Zotero 插件