2022 年第 1 期 第 17 卷

内镜下食管静脉曲张套扎联合卡维地洛或普萘洛尔治疗肝硬化食管静脉曲张再出血的随机对照研究

A randomized controlled study of endoscopic variceal ligation combined with carvedilol or propranolol in the treatment of esophageal variceal rebleeding in cirrhosis

作者：原姗姗刘家铭庄坤 张欣 杨振威唐海灵

英文作者：Yuan Shanshan Liu Jiaming Zhuang Kun Zhang Xin Yang Zhenwei Tang Hailing

单位：西安市中心医院消化科，西安710032

英文单位：Department of Gastroenterology Xi′an Central Hospital Xi′an 710032 China

关键词：肝硬化；食管静脉曲张；内镜套扎；卡维地洛

英文关键词：Cirrhosis；Esophagealvarices；Endoscopicligation；Carvedilol

• 摘要：

• 目的 探讨内镜下食管静脉曲张套扎（EVL）联合卡维地洛或普萘洛尔治疗肝硬化食管静脉曲张再出血的效果。方法 选取2016年7月至2018年7月西安市中心医院收治的肝硬化食管静脉曲张破裂出血患者126例，采用随机数字表法分为对照组A，对照组B和观察组，每组42例。对照组A行EVL联合安慰剂治疗，对照组B行EVL联合普萘洛尔治疗，观察组行EVL联合卡维地洛治疗。比较3组患者EVL治疗术后1、3、6个月及1年累积再出血发生率、累积生存率。比较3组患者EVL治疗前和术后1年肝脏硬度值（LSM）改善情况。结果 术后1年内，共36例患者出现食管静脉曲张破裂再出血（观察组6例，对照组A 17例，对照组B 13例）。术后3、6个月及1年观察组患者累积再出血发生率低于对照组A和对照组B，差异均有统计学意义（均P＜0.05）。术后1年，共16例患者死亡（观察组5例，对照组A 6例，对照组B 5例）。3组患者术后1、3、6个月及1年的累积生存率比较，差异均无统计学意义（均P＞0.05）。观察组患者术后1年的LSM水平低于治疗前［（20±7）kPa比（31±13）kPa］（P＜0.05），而对照组A和对照组B患者术后1年LSM水平与治疗前比较差异均无统计学意义（均P＞0.05）。结论  EVL联合卡维地洛可降低肝硬化食管静脉曲张破裂出血患者的再出血发生率，改善肝脏硬度。

• Objective   To investigate the effect of endoscopic variceal ligation (EVL) combined with carvedilol or propranolol in the treatment of esophageal variceal rebleeding in cirrhosis. Methods  From July 2016 to July 2018, 126 patients with esophageal variceal bleeding in cirrhosis in Xi′an Central Hospital were selected. The patients were divided into control group A, control group B and observation group by the random number table method. The control group A was treated with EVL combined with placebo, the control group B was treated with EVL combined with propranolol, and the observation group was treated with EVL combined with carvedilol. The cumulative rebleeding rate and cumulative survival rate were compared among the three groups 1, 3, 6 months and 1 year after EVL treatment. The improvement of liver stiffness measurement (LSM) before and 1 year after EVL was compared among the three groups. Results  Within 1 year after operation, 36 patients had esophageal variceal rebleeding (6 cases in the observation group, 17 cases in the control group A and 13 cases in the control group B). The cumulative rebleeding rate in the observation group at 3, 6 months and 1 year after operation was lower than that in the control group A and control group B (all P＜0.05). One year after operation, 16 patients died (5 cases in the observation group, 6 cases in the control group A and 5 cases in the control group B). There was no significant difference in cumulative survival rate in 1, 3, 6 months and 1 year after operation among the three groups (all P＞0.05). One year after operation, the LSM level in the observation group was lower than that before treatment ［(20±7)kPa vs (31±13)kPa］(P＜0.05), while there was no significant difference in the LSM level in the control group A and control group B before and after operation(both P＞0.05). Conclusion  EVL combined with carvedilol can reduce the incidence of rebleeding in patients with esophageal varices in cirrhosis, and improve liver stiffness.