健脾化湿止血方对肝硬化食管胃底静脉曲张破裂出血患者1年内再出血的影响

Effect of spleen-strengthening,dampness-removing,and hemostatic prescription on rebleeding within one year in cirrhotic patients with esophagogastric variceal bleeding

目的探讨健脾化湿止血方对肝硬化食管胃底静脉曲张破裂出血(EGVB)患者1年内发生再出血的影响。方法选取2008年8月-2016年10首都医科大学附属北京地坛医院收治的肝硬化EGVB患者750例,随访1年。根据累计日剂量(cDDD)将随访期内应用健脾化湿止血方中药剂量≥28 cDDD的患者纳入中药组(n=276),而服用中药<28 cDDD的患者被纳入非中药组(n=474)。正态分布的计量资料两组间比较采用t检验;非正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ2检验。采用多因素logistic回归分析EGVB再出血的影响因素。结果是否服用健脾化湿止血方是影响肝硬化EGVB患者1年内发生再出血的独立危险因素之一(比值比=0. 076,95%可信区间:0. 039~0. 126,P=0. 002)。中药组患者1年内再出血发生率显著低于非中药组(43. 5%vs 55. 1%,χ2=4. 246,P=0. 025)。中药组患者自随访至发生再出血的中位时间为95 d,非中药组为121 d,两组比较差异有统计学意义(Z=1. 981,P=0. 003)。结论健脾化湿止血方能够降低肝硬化EGVB患者1年内再出血风险,减少EGVB患者的再出血时间。

Objective To investigate the effect of spleen-strengthening,dampness-removing,and hemostatic prescription on rebleeding within one year in cirrhotic patients with esophagogastric variceal bleeding（ EGVB）. Methods A total of 750 cirrhotic patients with EGVB who were admitted to Beijing Ditan Hospital,Capital Medical University,from August 2008 to October 2016 were enrolled and followed up for one year. According to cumulative defined daily dose（ cDDD）,these patients were divided into traditional Chinese medicine（ TCM）group with 276 patients（ the dose of spleen-strengthening,dampness-removing,and hemostatic prescription ≥28 cDDD） and n＊ on-TCM group with 474 patients（ the dose of TCM 〈28 cDDD）. The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was used to determine the influencing factors for EGVB rebleeding. Results The presence or absence of the treatment with spleen-strengthening,dampness-removing,and hemostatic prescription was one of the independent risk factors for rebleeding within one year in cirrhotic patients with EGVB（ odds ratio = 0. 076,95% confidence interval： 0. 039-0. 126,P = 0. 002）. The TCM group had a significantly lower incidence rate of rebleeding within one year than the non-TCM group（ 43. 5% vs 55. 1%,χ^2= 4. 246,P = 0. 025）. The median time of rebleeding was 95 days in the TCM group and 121 days in the non-TCM group,and there was a significant difference between the two groups（ Z = 1. 981,P = 0. 003）. Conclusion Spleen-strengthening,dampness-removing,and hemostatic prescription can reduce the risk of rebleeding within one year in cirrhotic patients with EGVB and shorten the time of rebleeding.