内镜疗法后续应用粉防己碱预防食管静脉曲张破裂再出血的研究

Prophylactic effects of tetrandrine following endoscopic therapy for variceal rebleeding control

目的:研究内镜套扎术和(或)硬化剂治疗后续用粉防己碱预防肝硬化食管静脉破裂出血患者再出血的作用。方法:90例肝硬化并发食管胃底静脉曲张破裂出血患者,分成治疗组及对照组,2组均接受内镜治疗,继而都予以一般对症、保肝治疗,而治疗组加用粉防己碱(20mg,3次/d),疗程12个月,随访治疗期间出血复发率及静脉曲张复发率,同时实验前及实验结束时2组患者均行血流动力学检测及内镜检查。结果:治疗组患者出血复发率及静脉曲张复发率均明显低于对照组(P<0.05),治疗组患者血流动力明显改善(P<0.05),而对照组血流动力学无明显变化。结论:内镜套扎术和(或)硬化剂治疗后续用粉防己碱可明显降低肝硬化并食管静脉曲张出血患者的再出血率及静脉曲张复发率,其作用机制可能与抑制钙离子通道、提高一氧化氮合酶活性及抑制胶原纤维合成有关。

Objective To evaluate the prophylactic effects of tetrandrine following endoscopic banding ligation/sclerotherapy for variceal rebleeding control in patients with esophageal varices due to liver cirrhosis. Methods Ninety patients with rupture of esophageal varices due to liver cirrhosis were randomly divided into theraputic group and control group. The patients in the theraputic group were treated with tetrandrine following endoscopic therapy （n=45） for 12 months, while those in the control group received endoscopic therapy only （n=45）. The rates of variceal recurrence and rebleeding were observed. Meanwhile, the hemodynamic parameters and endoscopic examination in the both groups were followed-up prior to and after the treatment. Results The rates of variceal recurrence and rebleeding were all significantly reduced in the theraputic group than those in the control group （P〈0.05）. Meanwhile, the hemodynamic parameters in theraputic group was obviously meliorated after the treatment （P〈0.05）. In contrast, no significant changes of hemodynamitic parameters were observed in the control group. Conclusions Tetrandrine combined with endoscopic therapy could reduce the risk of of variceal recurrence and rebleeding in patients with liver cirrhosis. Its possible mechanism might be related with the inhibition of calcium channels, enhancement of nitric oxide synthase activity, and inhibition of collagen synthesis.