Liu Xiao, Xia Yifu, Zhu Junyuan, Liu Xiaochen, Xin Lixia, Wang Guangchuan, Zhang Mingyan, Li Zhen, Huang Guangjun, Zhang Chunqing
Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China.
Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jing Wu Wei Qi Road, Jinan, 250021, Shandong Province, China.
Dig Dis Sci. 2025 Apr 3. doi: 10.1007/s10620-025-09000-3.
Carvedilol is key for primary prophylaxis of high-risk variceal bleeding but is less studied for secondary prophylaxis with EVL. This study compares the long-term outcomes of carvedilol plus EVL versus propranolol plus EVL in secondary prophylaxis.
The long-term follow-up data regarding rebleeding, ascites recurrence, and survival of patients who were treated with EVL plus carvedilol (n = 147) or propranolol (n = 53) for secondary prophylaxis of variceal bleeding were compared.
Patients in the carvedilol group (n = 147) exhibited lower rebleeding rates (23.8% vs. 47.2%; hazard ratio(HR): 1.844; 95% confidence interval (CI) 1.099-3.096; p = 0.019) and ascites rates (7.5% vs. 30.2%; HR: 2.975; 95% CI 1.349-6.557; p = 0.003) compared to the propranolol group (n = 53). Cumulative mortality rates were similar between groups (12.2% vs. 30.2%; HR: 1.292; 95% CI 0.632-2.642; p = 0.48). In patients with viral cirrhosis, carvedilol resulted in lower rebleeding rates (HR: 2.236; 95% CI 1.188-4.208; p = 0.013) and improved ascites control (HR: 3.698; 95% CI 1.363-10.032; p = 0.010). Adjusted survival curves and 1:1 propensity score matching analyses confirmed these findings.
Our findings suggest that carvedilol combined with EVL may reduce rebleeding and ascites recurrence compared to propranolol in patients with cirrhosis, particularly those with viral etiologies. However, the lack of mortality benefit and limited generalizability to non-viral cirrhosis necessitate further validation in prospective trials.
卡维地洛是预防高危静脉曲张出血的关键药物，但在与内镜下静脉曲张结扎术（EVL）联合用于二级预防方面的研究较少。本研究比较了卡维地洛联合EVL与普萘洛尔联合EVL在二级预防中的长期疗效。
比较了接受EVL联合卡维地洛（n = 147）或普萘洛尔（n = 53）进行静脉曲张出血二级预防的患者的再出血、腹水复发和生存的长期随访数据。
与普萘洛尔组（n = 53）相比，卡维地洛组（n = 147）患者的再出血率较低（23.8% 对 47.2%；风险比（HR）：1.844；95% 置信区间（CI）1.099 - 3.096；p = 0.019），腹水发生率也较低（7.5% 对 30.2%；HR：2.975；95% CI 1.349 - 6.557；p = 0.003）。两组的累积死亡率相似（12.2% 对 30.2%；HR：1.292；95% CI 0.632 - 2.642；p = 0.48）。在病毒性肝硬化患者中，卡维地洛导致较低的再出血率（HR：2.236；95% CI 1.188 - 4.208；p = 0.013）并改善了腹水控制（HR：3.698；95% CI 1.363 - 10.032；p = 0.010）。调整后的生存曲线和1:1倾向评分匹配分析证实了这些发现。
我们的研究结果表明，与普萘洛尔相比，卡维地洛联合EVL可能降低肝硬化患者，尤其是病毒性病因患者的再出血和腹水复发。然而，缺乏死亡率获益以及对非病毒性肝硬化的可推广性有限，需要在前瞻性试验中进一步验证。
