摘要
目的 肝静脉压力梯度(HVPG)是肝硬化病情评估、判断预后的重要指标,本研究探索依据患者不同HVPG值采取不同术式降低肝硬化食管静脉曲张患者再出血率的价值。方法 收集2010年4月至2019年10月既往有消化道出血病史、行HVPG测定的270例肝硬化食管静脉曲张患者为观察对象。其中130例患者(HVPG指导组)根据HVPG值选择不同术式进行个体化治疗:10 mmHg≤HVPG≤16 mmHg的患者采用内镜下食管静脉曲张套扎术(EVL)联合非选择性β受体阻断剂(NSBB)治疗;16 mmHg<HVPG≤20 mmHg的患者采用经皮经肝胃食管静脉曲张栓塞术(PTVE)治疗;HVPG>20 mmHg的患者则使用经颈静脉肝内门体分流术(TIPS)治疗。另外140例患者(非HVPG指导组)均采用EVL联合NSBB治疗。观察主要终点为门脉高压相关再出血,次要终点为死亡。结果 中位随访时间为26个月。HVPG指导组再出血率低于非HVPG指导组(12.31%比30.00%,P=0.000 88),但两组生存率无明显差异(93.08%比91.43%,P=0.71)。进一步亚组分析显示,对于16 mmHg<HVPG≤20 mmHg患者,PTVE治疗的再出血率低于EVL+NSBB治疗(5.00%比31.82%,P=0.02),但两组生存率无明显差异;对于HVPG>20 mmHg的患者,TIPS治疗的再出血率低于EVL+NSBB治疗(6.12%比36.36%,P=0.000 88),两组生存率仍无明显差异。结论 基于HVPG的个体化治疗具有重要理论和临床意义,根据HVPG的风险分层,个体化选择食管静脉曲张出血二级预防治疗方案(EVL+NSBB、PTVE或TIPS)可降低静脉再出血率,为肝硬化患者的个体化治疗提供新的研究思路。
Objective Hepatic venous pressure gradient(HVPG)is an important indicator for the evaluation and prognosis of liver cirrhosis.This study explores the value of different procedures according to HVPG for reducing the rate of rebleeding in cirrhotic patients with esophageal varices.Methods A total of 270 cirrhotic patients with esophageal varices who had a history of variceal bleeding and HVPG performance from April 2010 to October 2019 were enrolled.Among them,130 patients(HVPG guided group)underwent individualized treatment according to HVPG value:patients with 10 mmHg≤HVPG≤16 mmHg accepted endoscopic esophageal variceal ligation(EVL)combined with non-selectiveβreceptor blocker(NSBB)treatment;patients with 16 mmHg<HVPG≤20 mmHg underwent percutaneous transhepatic variceal embolization (PTVE);for patients with HVPG>20 mmHg,transjugular intrahepatic portosystemic shunt(TIPS)was used.Another 140 patients(non-HVPG guided group)were treated with EVL plus NSBB.The primary end point was rebleeding associated with portal hypertension,and the secondary end point was death.Results The median follow-up time was 26 months.The rate of rebleeding in the HVPG guided group was lower than that in the non-HVPG guided group(12.31% vs.30.00%,P=0.000 88),but there was no significant difference in survival between the two groups(93.08% vs.91.43%,P=0.71).Further subgroup analysis showed that for patients with 16 mmHg<HVPG≤20 mmHg,the rebleeding rate of patients with PTVE treatment was lower than that of patients with EVL+NSBB(5.00% vs.31.82%,P=0.02),but there was no significant difference in survival between the two groups.In patients with HVPG>20 mmHg,the rebleeding rate of patients with TIPS was lower than that of patients with EVL+NSBB(6.12% vs.36.36%,P=0.000 88),but there was no significant difference in survival between the two groups.Conclusion Individualized therapy based on HVPG has important theoretical and clinical significance.According to the risk stratification of HVPG,individualized choice of secondary prevention o
作者
王思宁
王广川
张明艳
黄广军
陈世耀
张春清
Wang Sining;Wang Guangchuan;Zhang Mingyan;Huang Guangjun;Chen Shiyao;Zhang Chunqing(Department of Gastroenterology,Shandong Provincial Hospital Affiliated to Shandong University,Jinan 250021,China;Department of Gastroenterology and Hepatology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《中华消化病与影像杂志（电子版）》
2019年第6期256-262,共7页
Chinese Journal of Digestion and Medical Imageology(Electronic Edition)
基金
国家自然科学基金(81770606)
关键词
肝硬化
个体化治疗
肝静脉压力梯度
经皮经肝胃食管静脉曲张栓塞术
经颈静脉肝内门体分流术
Liver cirrhosis,Individualized treatment
Hepatic vein pressure gradient
Percutaneous transhepatic variceal embolization
Transjugular intrahepatic portosystemic shunt
