急性静脉曲张出血：奥曲肽是否改善不同肝功能储备患者的结局？

Acute Variceal Bleeding: Does Octreotide Improve Outcomes in Patients with Different Functional Hepatic Reserve?

机构信息

Servicio de Gastroenterología, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, México.

Cirrhosis Care Clinic, Division of Gastroenterology (Liver Unit), University of Alberta, Canada.

出版信息

Ann Hepatol. 2018 January-February;17(1):125-133. doi: 10.5604/01.3001.0010.7544.

DOI:10.5604/01.3001.0010.7544

PMID:29311398

Abstract

BACKGROUND

Current guidelines do not differentiate in the utilization of vasoactive drugs in patients with cirrhosis and acute variceal bleeding (AVB) depending on liver disease severity.

MATERIAL AND METHODS

In this retrospective study, clinical outcomes in 100 patients receiving octreotide plus endoscopic therapy (ET) and 216 patients with ET alone were compared in terms of failure to control bleeding, in-hospital mortality, and transfusion requirements stratifying the results according to liver disease severity by Child-Pugh (CP) score and MELD.

RESULTS

In patients with CP-A or those with MELD < 10 octreotide was not associated with a better outcome compared to ET alone in terms of hospital mortality (CP-A: 0.0 vs. 0.0%; MELD < 10: 0.0 vs. 2.9%, p = 1.00), failure to control bleeding (CP-A: 8.7 vs. 3.7%, p = 0.58; MELD < 10: 5.3 vs. 4.3%, p = 1.00) and need for transfusion (CP-A: 39.1 vs. 61.1%, p = 0.09; MELD < 10: 63.2 vs. 62.9%, p = 1.00). Those with severe liver dysfunction in the octreotide group showed better outcomes compared to the non-octreotide group in terms of hospital mortality (CP-B/C: 3.9 vs. 13.0%, p = 0.04; MELD ≥ 10: 3.9 vs. 13.3%, p = 0.03) and need for transfusion (CP-B/C: 58.4 vs. 71.6%, p = 0.05; MELD ≥ 10: 50.6 vs. 72.7%, p < 0.01). In multivariate analysis, octreotide was independently associated with in-hospital mortality (p = 0.028) and need for transfusion (p = 0.008) only in patients with severe liver dysfunction (CP-B/C or MELD ≥ 10).

CONCLUSION

Patients with cirrhosis and AVB categorized as CP-A or MELD < 10 had similar clinical outcomes during hospitalization whether or not they received octreotide.

摘要

背景

目前的指南并没有根据肝脏疾病的严重程度，对肝硬化合并急性静脉曲张出血（AVB）患者使用血管活性药物进行区分。

材料和方法

在这项回顾性研究中，比较了 100 例接受奥曲肽联合内镜治疗（ET）和 216 例仅接受 ET 的患者的临床结局，根据 Child-Pugh（CP）评分和 MELD 分层，比较了出血控制失败、住院死亡率和输血需求等方面的差异。

结果

在 CP-A 患者或 MELD < 10 的患者中，与单独接受 ET 相比，奥曲肽并不能改善住院死亡率（CP-A：0.0 与 0.0%；MELD < 10：0.0 与 2.9%，p=1.00）、出血控制失败（CP-A：8.7 与 3.7%，p=0.58；MELD < 10：5.3 与 4.3%，p=1.00）和输血需求（CP-A：39.1 与 61.1%，p=0.09；MELD < 10：63.2 与 62.9%，p=1.00）。在奥曲肽组中，肝功能严重受损的患者在住院死亡率（CP-B/C：3.9 与 13.0%，p=0.04；MELD ≥ 10：3.9 与 13.3%，p=0.03）和输血需求（CP-B/C：58.4 与 71.6%，p=0.05；MELD ≥ 10：50.6 与 72.7%，p < 0.01）方面的结局优于非奥曲肽组。多变量分析显示，奥曲肽仅与肝功能严重受损（CP-B/C 或 MELD ≥ 10）患者的住院死亡率（p=0.028）和输血需求（p=0.008）独立相关。