随访方式对非选择性β受体阻滞剂预防食管胃静脉曲张出血患者依从性及预后的影响分析

Comparison of follow-up methods on compliance and prognosis of non-selective beta blockers for prevention of esophagogastric variceal bleeding

目的探讨随访方式对非选择性β受体阻滞剂(NSBBs)二级预防食管胃静脉曲张破裂出血(EGVB)非住院患者服药依从性及预后的影响。方法2018年7月至2019年4月在武汉大学人民医院消化内科就诊的门静脉高压合并食管胃静脉曲张(EGV)患者,按照随机数字表法随机纳入传统门诊随访组(A组)、远程平台随访组(B组)和联合随访组(C组)。记录患者服药依从性、心率应答、病情变化及治疗情况,对不同方式随访患者NSBBs服药依从性及其影响因素和预后进行分析。结果最终纳入72例患者,其中A组24例,B组23例,C组25例。40例患者(55.6%)NSBBs服药依从性好,其中34例(85.0%)达到心率应答。B组(65.2%,15/23)与C组(68.0%,17/25)服药依从性高于A组(33.3%,8/24),差异有统计学意义(χ^2=4.778,P=0.029;χ^2=5.889,P=0.015);B组与C组比较差异无统计学意义(χ^2=0.042,P=0.838)。A组依从性好亚组与依从性差亚组比较,本地患者比例高[7/8比37.5%(6/16),P=0.033]。随访期间NSBBs服药依从性好患者较依从性差患者胃镜复查比例高[75.0%(30/40)比21.9%(7/32),χ^2=20.085,P<0.001];并发EGVB患者少,但差异无统计学意义[5.0%(2/40)比21.9%(7/32),P=0.073]。结论门静脉高压合并EGV患者NSBBs服药依从性不高。远程平台随访可提高药物预防依从性,是一种较好的随访方式。NSBBs服药依从性好的患者胃镜复查依从性高,以胃镜复查结果为基础评估曲张静脉出血风险及内镜序贯治疗有望降低EGVB风险。

Objective To compare the different follow-up methods on compliance and prognosis of non-selective beta blockers(NSBBs)for out-patients with secondary prevention of esophagogastric variceal bleeding(EGVB).Methods A total of 72 patients with portal hypertension and esophageal gastric varices(EGV),who were admitted to the department of gastroenterology,Renmin Hospital of Wuhan University from July 2018 to April 2019 were randomly included in the traditional outpatient follow-up group(group A,24),remote platform follow-up group(group B,23)and combined follow-up group(group C,25)according to the random number table.The patient′s medication compliance,heart rate response,condition change and treatment were recorded.NSBBs medication compliance,influencing factors and prognosis of patients in different groups were analyzed.Results Forty(40/72,55.6%)patients had good compliance with NSBBs,among which 34(34/40,85.0%)achieved heart rate response.The medication compliance of the group B(15/23,65.2%)and the group C(17/25,68.0%)was higher than that of the group A(8/24,33.3%;χ^2=4.778,P=0.029;χ^2=5.889,P=0.015,respectively).There was no significant difference in the medication compliance between the group B and the group C(χ^2=0.042,P=0.838).In the group A,the subgroup of good compliance had higher proportion of local patients than that of poor compliance subgroup[7/8 VS 37.5%(6/16),P=0.033].Patients with good drug compliance had higher proportion of gastroscopy review than that of poor compliance patients[75.0%(30/40)VS 21.9%(7/32),χ^2=20.085,P<0.001]and less patients with EGVB[5.0%(2/40)VS 21.9%(7/32),P=0.073].Conclusion Patients with portal hypertension and EGV have poor compliance with NSBBs.Remote platform follow-up is a better way to improve compliance of drug prevention.Patients with good NSBBs compliance have a higher compliance of gastroscopy review.The risk assessment of variceal bleeding and endoscopic sequential therapy based on the results of gastroscopy review are expected to reduce the risk of EGVB.