临床肝胆病杂志2025，Vol.42Issue(5)：900-906,7.DOI:10.12449/JCH250515
单用卡维地洛与联合内镜下静脉曲张套扎术对肝硬化食管胃静脉曲张破裂出血二级预防的效果比较
Effectiveness of carvedilol alone versus carvedilol combined with endoscopic variceal ligation in secondary prevention of gastroesophageal variceal bleeding in patients with liver cirrhosis
摘要
Abstract
Objective To compare the therapeutic effects of carvedilol alone and carvedilol combined with endoscopic variceal ligation(EVL)in the prevention of re-bleeding from gastroesophageal varices,and to provide strategies for clinical treatment.Methods We retrospectively included 178 patients who had received carvedilol alone or carvedilol plus EVL to prevent gastroesophageal variceal re-hemorrhage from October 2010 to June 2023.They were divided into carvedilol alone group(47 cases)and carvedilol+EVL group(131 cases).Between-group comparisons were conducted using the paired t test for normally distributed continuous data,the Mann-Whitney U test for non-normally distributed continuous data,and the chi-square test for categorical data.A Cox proportional hazards model was employed for univariable and multi-variable analyses.The cumulative incidence rates of re-bleeding and mortality were estimated using the Kaplan-Meier method.The baseline characteristics of the two groups were matched through propensity score matching(PSM)to reduce selection bias and enhance the credibility of causal inference.Results The re-bleeding rate of the carvedilol+EVL group was significantly lower than that of the carvedilol alone group(10-year cumulative incidence:29.8%vs 36.2%,hazard ratio[HR]=0.505,95%confidence interval[CI]:0.292-0.847,P=0.015).There was no significant difference in liver-related mortality(10-year cumulative incidence:21.3%vs 21.4%,HR=0.799,95%CI:0.406-1.578,P=0.518).The results were stable with PSM analysis.The Cox regression analysis revealed that creatinine was an independent risk factor affecting re-bleeding(HR=1.004,95%CI:1.001-1.008,P=0.011)and liver-related mortality(HR=1.004,95%CI:1.001-1.007,P=0.019).Conclusion Carvedilol combined with EVL is better than carvedilol alone in the prevention of gastroesophageal variceal re-bleeding.关键词
肝硬化/食管和胃静脉曲张/套扎疗法/卡维地洛/二级预防Key words
Liver Cirrhosis/Esophageal and Gastric Varices/Cuff Ligating Therapy/Carvedilol/Secondary Prevention引用本文复制引用
刘晓晨,夏翊夫,张春清..单用卡维地洛与联合内镜下静脉曲张套扎术对肝硬化食管胃静脉曲张破裂出血二级预防的效果比较[J].临床肝胆病杂志,2025,42(5):900-906,7.基金项目
国家自然科学基金(81970533) （81970533）
山东省自然科学基金(ZR2022ZD21) National Natural Science Foundation of China(81970533) （ZR2022ZD21）
Natural Science Foundation of Shandong Province(ZR2022ZD21) （ZR2022ZD21）
