质子泵抑制剂降低预防性内镜静脉曲张套扎术后早期出血风险的临床研究

Clinical effect of Proton-pump inhibitors to reduce the risk of early bleeding after prophylactic endoscopic varicose ligation

目的探讨预防性内镜静脉曲张套扎术(EVL)后出血的相关危险因素,并评估质子泵抑制剂(PPI)的治疗效果。方法该研究为回顾性队列研究,共纳入505例首次接受预防性EVL的肝硬化并发食管静脉曲张高危患者。EVL后出血是指预防性EVL术后8周内出血,出血症状包括:黑便或呕血,血红蛋白降低>2.0 g/dl。如内镜确诊为溃疡EVL手术部位出血,则定义为EVL后溃疡出血。结果该组患者中14例患者预防性EVL术后出血。单因素分析显示,EVL术后出血的危险因素包括:饮酒、低白蛋白、高总胆红素、高Child-Pugh评分、高终末期肝病模型(MELD)评分、伴随胃底静脉曲张以及不使用PPI药物治疗。多因素Logistic分析显示,伴随胃底静脉曲张(OR=5.680,P=0.005)和不使用PPI(OR=8.217,P=0.002)与预防性EVL后出血有关。进一步排除接受胃底静脉曲张治疗的患者,发现未使用PPI药物(OR=8.827,P=0.008)是EVL术后出血相关的唯一危险因素。结论行预防性EVL术患者应考虑采用PPI治疗,能降低预防性EVL后出血风险。

Objective To analyze the factors associated with bleeding after prophylactic endoscopic varicose ligation(EVL)and to assess the effect of Proton-pump inhibitors(PPI)therapy.Methods 505 cirrhotic patients with high risk esophageal varices who received primary prophylactic EVL were included for this retrospective cohort study.Post-EVL bleeding was defined as bleeding after prophylactic EVL within 8 weeks evidenced by the occurrence of melena or hematemesis,or by a decrease of hemoglobin by>2.0 g/dl.If evidence of bleeding from ulceration of the EVL sites was confirmed by endoscopy,we defined it as post-EVL ulcer bleeding.Results 14 patients developed bleeding after prophylactic EVL.Factors associated with post-EVL bleeding included alcohol as etiology,low albumin,high total bilirubin,high Child-Pugh score,high MELD score,coexistence of gastric varices,and not administrating PPI medication by univariate analysis.In multivariate logistic analysis,Co-existing gastric varix(OR^=5.680,P=0.005)and not administrating PPIs(OR^=8.217,P=0.002)were associated with bleeding after prophylactic EVL.In the subgroup analysis excluding patients whose gastric varices were treated,not administering PPI medication(OR=8.827,P=0.008)was the sole factor associated with post-EVL bleeding.Conclusion PPI therapy needs to be considered in patients receiving prophylactic EVL to reduce the risk of bleeding after prophylactic EVL.