Hung Tsung-Hsing, Tsai Chen-Chi, Tseng Chih-Wei, Tseng Kuo-Chih, Hsieh Yu-Hsi, Tsai Chih-Chun
Departments of aInternal Medicine, Division of Gastroenterology bMedicine, Division of Infectious Disease, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi cSchool of Medicine, Tzuchi University, Hualien dDepartment of Mathematics, Tamkang University, Tamsui, Taiwan.
Eur J Gastroenterol Hepatol. 2016 Nov;28(11):1275-9. doi: 10.1097/MEG.0000000000000703.
To study the differences in mortality between terlipressin and somatostatin treatments in cirrhotic patients with esophageal variceal bleeding (EVB) and renal functional impairment (RFI).
The National Health Insurance Database, part of the Taiwan National Health Insurance Program, was used to enroll cirrhotic patients who had received endoscopic variceal ligation plus somatostatin or terlipressin for EVB and who were hospitalized between 1 January 2007 and 31 December 2010. The differences in mortality between the two vasoactive agents were compared and the risk factors for 30-day mortality because of EVB were identified.
A total of 2324 cirrhotic patients with EVB were enrolled. The 30-day mortality data showed no significant differences between the somatostatin and the terlipressin groups (P=0.232). The risk of 30-day mortality was significantly higher in male patients [hazard ratio (HR): 1.50, P=0.002] and patients with hepatic encephalopathy (HR: 1.82, P<0.001), ascites (HR: 1.32, P=0.008), bacterial infections (HR: 2.10, P<0.001), hepatocellular carcinoma (HR: 2.09, P<0.001), and RFI (HR: 3.89, P<0.001). A subgroup analysis of cirrhotic patients with RFI was carried out. The overall 30-day mortality was higher in patients treated with somatostatin than in those treated with terlipressin (52.6 vs. 42.3%), but the difference failed to reach significance (adjust HR: 1.49, 95% confidence interval: 0.94-2.37, P=0.091).
RFI was the most important risk factor for 30-day mortality in EVB patients. Terlipressin and somatostatin had similar effects on 30-day mortality in cirrhotic patients with EVB and RFI.
研究特利加压素与生长抑素治疗肝硬化合并食管静脉曲张破裂出血（EVB）及肾功能损害（RFI）患者的死亡率差异。
利用台湾全民健康保险计划的全民健康保险数据库，纳入2007年1月1日至2010年12月31日期间因EVB接受内镜下静脉曲张套扎术加生长抑素或特利加压素治疗并住院的肝硬化患者。比较两种血管活性药物的死亡率差异，并确定因EVB导致30天死亡率的危险因素。
共纳入2324例肝硬化合并EVB患者。30天死亡率数据显示，生长抑素组与特利加压素组之间无显著差异（P = 0.232）。男性患者[风险比（HR）：1.50，P = 0.002]、肝性脑病患者（HR：1.82，P < 0.001）、腹水患者（HR：1.32，P = 0.008）、细菌感染患者（HR：2.10，P < 0.001）、肝细胞癌患者（HR：2.09，P < 0.001）和RFI患者（HR：3.89，P < 0.001）的30天死亡风险显著更高。对合并RFI的肝硬化患者进行了亚组分析。生长抑素治疗患者的总体30天死亡率高于特利加压素治疗患者（52.6%对42.3%），但差异未达到显著水平（校正HR：1.49，95%置信区间：0.94 - 2.37，P = 0.091）。
RFI是EVB患者30天死亡率的最重要危险因素。特利加压素和生长抑素对肝硬化合并EVB及RFI患者的30天死亡率有相似影响。
