血小板减少症对肝硬化急性静脉曲张出血患者内镜下静脉曲张治疗失败的影响。
Impact of thrombocytopenia on failure of endoscopic variceal treatment in cirrhotic patients with acute variceal bleeding.
作者信息
He Yan, Romeiro Fernando Gomes, Sun Mingyu, Ji Fanpu, Zhu Qiang, He Yingli, Ma Dapeng, Yuan Shanshan, Liu Xiaofeng, Philips Cyriac Abby, Basaranoglu Metin, Méndez-Sánchez Nahum, Pinyopornpanish Kanokwan, Li Yiling, Wu Yunhai, Yang Ling, Shao Lichun, Mancuso Andrea, Chen Yu, Tacke Frank, Lin Su, Liu Lei, Li Bimin, Qi Xingshun
机构信息
Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (Teaching Hospital of China Medical University), Shenyang, China.
Botucatu Medical School, São Paulo State University, Botucatu, Brazil.
出版信息
Therap Adv Gastroenterol. 2025 Jan 4;18:17562848241306934. doi: 10.1177/17562848241306934. eCollection 2025.
BACKGROUND
Acute variceal bleeding (AVB), a life-threatening complication of liver cirrhosis, can be effectively treated by endoscopy, but there is a risk of early rebleeding after endoscopic variceal treatment (EVT). Thrombocytopenia is the most common hemostatic abnormality in liver cirrhosis. However, it is still unclear about whether thrombocytopenia increases the failure of EVT in cirrhotic patients with AVB.
OBJECTIVES
We investigated the association between thrombocytopenia and the failure of EVT in cirrhotic patients with AVB.
DESIGN
International multicenter, retrospective study.
METHODS
Overall, 2467 cirrhotic patients with acute gastrointestinal bleeding who were enrolled into an international multicenter study between September 30, 2020 and June 30, 2023 were retrospectively screened. Thrombocytopenia was defined as platelet count below 150 × 10/L and further classified as mild (100 × 10/L-150 × 10/L), moderate (50 × 10/L-100 × 10/L), and severe (<50 × 10/L). A 1:1 propensity score matching (PSM) analysis was performed. Five-day failure to control bleeding was evaluated.
RESULTS
Overall, 1079 patients were included, of whom 923 (85.5%) had thrombocytopenia, including mild ( = 241), moderate ( = 445), and severe ( = 237) thrombocytopenia. PSM analysis demonstrated that the rate of 5-day failure to control bleeding was not significantly different between patients with and without thrombocytopenia (mild: (12/153) 7.8% vs (7/153) 4.6%, = 0.236; moderate: (9/155) 5.8% vs (7/155) 4.5%, = 0.608; or severe: (5/132) 3.8% vs (7/132) 5.3%, = 0.555).
CONCLUSION
Thrombocytopenia may not influence the efficacy of EVT in cirrhotic patients with AVB.
背景
急性静脉曲张出血（AVB）是肝硬化的一种危及生命的并发症，可通过内镜检查有效治疗，但内镜下静脉曲张治疗（EVT）后存在早期再出血风险。血小板减少是肝硬化最常见的止血异常。然而，血小板减少是否会增加肝硬化合并AVB患者EVT治疗失败的风险仍不清楚。
目的
我们研究了肝硬化合并AVB患者血小板减少与EVT治疗失败之间的关联。
设计
国际多中心回顾性研究。
方法
总体而言，对2020年9月30日至2023年6月30日期间纳入一项国际多中心研究的2467例肝硬化急性胃肠道出血患者进行回顾性筛查。血小板减少定义为血小板计数低于150×10⁹/L，并进一步分为轻度（100×10⁹/L - 150×10⁹/L）、中度（50×10⁹/L - 100×10⁹/L）和重度（<50×10⁹/L）。进行1:1倾向评分匹配（PSM）分析。评估5天内控制出血失败的情况。
结果
共纳入1079例患者，其中923例（85.5%）有血小板减少，包括轻度血小板减少（n = 241）、中度血小板减少（n = 445）和重度血小板减少（n = 237）。PSM分析表明，血小板减少患者和未患血小板减少患者5天内控制出血失败的发生率无显著差异（轻度：(12/153) 7.8% 对 (7/153) 4.6%，P = 0.236；中度：(9/155) 5.8% 对 (7/155) 4.5%，P = 0.608；重度：(5/132) 3.8% 对 (7/132) 5.3%，P = 0.555）。
结论
血小板减少可能不会影响肝硬化合并AVB患者EVT的疗效。
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