卡维地洛与普萘洛尔预防肝硬化食管胃静脉曲张首次出血的疗效研究

Study on the efficacy of carvedilol and propranolol in preventing first hemorrhage of cirrhotic esophagogastric varices

目的比较卡维地洛与普萘洛尔预防肝硬化食管胃静脉曲张首次出血的临床效果。方法选取该院2010年5月至2017年12月经胃镜等检查明确为肝硬化合并中、重度食管胃静脉曲张而既往无消化道出血病史的71例患者作为研究对象,分为卡维地洛组(n=35)与普萘洛尔组(n=36)。以静脉曲张破裂出血、死亡为主要终点事件。结果两组年龄、性别、肝硬化病因、曲张静脉程度、Child-Pugh分级比较,差异无统计学意义(P>0.05)。卡维地洛组平均随访(21.2±8.8)个月,发生食管胃静脉曲张破裂出血13例,死亡15例;普萘洛尔组平均随访(18.2±8.3)个月,发生食管胃静脉曲张破裂出血11例,死亡16例。Kaplan-Meier曲线Log-Rank检验显示两组在曲张静脉出血及生存比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示曲张静脉程度(OR=6.479,95%CI:1.896~22.142)、Child-Pugh分级(OR=4.896,95%CI:1.641~14.604)与出血风险呈正相关,病因为乙肝肝硬化者(OR=0.306,95%CI:0.101~0.929)与出血风险呈负相关。Child-Pugh分级(OR=3.361,95%CI:1.227~9.206)是死亡风险的唯一独立预测因素。结论卡维地洛在预防肝硬化食管胃静脉曲张首次出血及改善预后方面并不优于普萘洛尔。

Objective To compare the clinical effect of carvedilol and propranolol in preventing first hemorrhage of cirrhotic esophagogastric varices.Methods From May 2010 to December 2017,71 patients with cirrhosis and moderate or severe esophagogastric varices who had no previous history of gastrointestinal bleeding were included,then divided into the carvedilol group(n=35)and the propranolol group(n=36).The main endpoint was variceal bleeding and death.Results There were no significant differences in age,gender,etiology of cirrhosis,degree of esophagogastric varices,and Child-Pugh classification between the two groups.In the carvedilol group,the average follow-up time was(21.2±8.8)months,13 cases of esophagogastric variceal hemorrhage occurred,and 15 cases died.The average follow-up of the propranolol group was(18.2±8.3)months,11 cases of esophagogastric variceal hemorrhage occurred,and 16 cases died.Kaplan-Meier plots with Log-Rank test showed that there was no significant difference between the two groups in variceal hemorrhage and survival(P>0.05).Multivariate Logistic regression analysis showed that the degree of varices(OR=6.479,95%CI:1.896—22.142)and Child-Pugh grade(OR=4.896,95%CI:1.641—14.604)were positively correlated with bleeding risk,and patients with hepatitis B cirrhosis(OR=0.306,95%CI:0.101—0.929)was negatively associated with bleeding risk.The Child-Pugh grade(OR=3.361,95%CI:1.227—9.206)was the only independent predictor of risk of death.Conclusion Carvedilol is not superior to propranolol in preventing first hemorrhage of esophagogastric varices and improving prognosis in patients with cirrhosis.