抗炎治疗促进肝硬化出血患者门静脉血栓再通的队列研究

Cohort study on promotion of antibiotic therapy to recanalization of portal vein thrombosis in cirrhotic patients with gastroesophageal variceal bleeding

目的肝硬化肠道炎症参与门脉血栓的形成与进展,探索抗炎治疗是否促进肝硬化食管胃静脉曲张破裂出血合并门静脉血栓患者短期内血栓再通,为肝硬化门脉高压抗炎治疗提供更多证据。方法采用队列研究方法,在肝硬化门脉高压静脉曲张数据库中选取2018年1月1日至2021年3月1日因急诊出血就诊复旦大学附属中山医院的肝硬化患者,采用增强CT确认其存在门静脉血栓,按照是否应用抗生素分组,在患者后续短期连续观察的病程中,增强CT随访门静脉血栓再通情况,权衡其他因素,用生存曲线评估两组的血栓再通差异。结果共124例肝硬化食管胃静脉曲张破裂出血合并门静脉血栓的患者纳入本研究,其中70例应用抗生素治疗,54例未应用抗生素治疗。中位随访时间182.00(126.00~245.75)d,抗生素组门静脉血栓再通率显著高于无抗生素组(30.00%比14.81%,P=0.048)。结论抗生素治疗可促进肝硬化食管胃静脉曲张破裂出血合并门静脉血栓的患者短期内门静脉血栓的再通。

Objective To explore whether antibiotic therapy could promote short-term thrombus recanalization in cirrhotic patients with portal vein thrombosis(PVT)who had underwent acute gastroesophageal variceal bleeding as intestinal inflammation is involved in the initiation and progression of PVT.Methods This cohort studyscreened cirrhotic PVT patients with gastroesophageal variceal bleeding who visited the emergency department of Zhongshan Hospital affiliated to Fudan University between January 1,2018 and March 1,2021 from the established database of cirrhotic portal hypertensive varices.The presence of PVT was confirmed using enhanced computer tomography(CT)and patients were grouped according to whether antibiotics were applied.During the subsequent short-term observation of the patients’courses,CT was conducted to follow up thrombus recanalization,and the difference betweentwo groups was analyzed with survival curves.Results A total of 124 patients were included in this study,among whom 70 patients were treated with antibiotics and 54 patients were not treated with antibiotics.The median follow-up time was 182.00(126.00-245.75)days and the recanalization rate of PVT in antibiotic group was significantly higher than that in non-antibiotic group(30.00%vs.14.81%,P=0.048).Conclusion Antibiotics can promote short-term PVT recanalization in cirrhotic patients with acute gastroesophageal variceal bleeding.