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中华消化病与影像杂志(电子版)

中华消化病与影像杂志(电子版) ›› 2022, Vol. 12 ›› Issue (04) : 236 -240. doi: 10.3877/cma.j.issn.2095-2015.2022.04.010

综述

食管-胃底静脉曲张破裂出血内镜治疗后再出血高危因素研究进展
刘黎明1, 张春清2,†()   
  1. 1. 250021　济南，山东大学附属省立医院消化内科
    2. 250021　济南，山东大学附属省立医院消化内科；250021　济南，山东第一医科大学附属省立医院消化内科
  • 收稿日期:2021-12-15 出版日期:2022-08-01
  • 通信作者: 张春清
  • 基金资助:
    国家自然科学基金面上项目(81970533); 国家自然科学基金青年课题(82000566)

Advances in high risk factors of rebleeding after endoscopic treatment of esophagogastric variceal bleeding

Liming Liu1, Chunqing Zhang2,†()   

  1. 1. Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
    2. Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China; Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
  • Received:2021-12-15 Published:2022-08-01
  • Corresponding author: Chunqing Zhang
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刘黎明, 张春清. 食管-胃底静脉曲张破裂出血内镜治疗后再出血高危因素研究进展[J]. 中华消化病与影像杂志(电子版), 2022, 12(04): 236-240.

Liming Liu, Chunqing Zhang. Advances in high risk factors of rebleeding after endoscopic treatment of esophagogastric variceal bleeding[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2022, 12(04): 236-240.

食管-胃底静脉曲张破裂出血（EGVB）是肝硬化门静脉高压常见的并发症，标准药物和内镜治疗后仍有较高再出血率和死亡率。研究发现，Child-Pugh C级、中重度腹水、门静脉血栓（PVT）、曲张静脉套扎环数较多、食管静脉曲张范围较大、门静脉高压性胃病、凝血酶原时间（PT）>18 s、血红蛋白（HGB）水平较低、国际标准化比值（INR）较高和低蛋白血症是EGVB内镜治疗6周内再出血的独立危险因素，除HGB水平、腹水程度、Child-Pugh分级外，糖尿病、酒精性肝硬化、肝癌、谷草转氨酶（GOT）水平、肝硬度（LSM）及基于4因子纤维化指数（FIB-4）、白蛋白-胆红素（ALBI）评分可作为EGVB内镜治疗6周后再出血的独立预测因素。根据以上因素及评分系统，可筛选出EGVB内镜治疗后再出血高危患者，实施选择性干预措施，降低再出血率，改善预后。本文对肝硬化EGVB及特殊类型胃静脉曲张破裂出血（GVB）内镜治疗后早期及远期再出血的影响因素和高风险人群进行综述。

关键词: 食管-胃底静脉曲张破裂出血, 肝硬化, 内镜治疗, 再出血, 危险因素

Esophago-gas-tric fundal varices bleeding (EGVB) is a common complication of portal hypertension in cirrhosis, which still has high rebleeding rate and mortality after standard drug and endoscopic treatment. The studies have found that Child-Pugh grade C, moderate to severe ascites, portal vein thrombosis (PVT), more ligature rings, larger range of esophageal varices, portal hypertensive gastropathy, prothrombin time (PT) >18 s, lower hemoglobin (HGB), higher international standardized ratio (INR) and hypoproteinemia are independent risk factors for rebleeding within 6 weeks after endoscopic therapy. In addition to HGB level, ascites degree and Child-Pugh grade, diabetes, alcoholic liver cirrhosis, liver cancer, aspartate aminotransferase (AST), liver stiffness measurement (LSM), and fibrosis 4 score (FIB-4) and albumin-bilirubin (ALBI) score are independent predictors of long-term rebleeding after 6 weeks of endoscopic therapy. According to the above factors and scoring system, patients with high risk of rebleeding can be screened, and selective intervention measures can be implemented to reduce the rebleeding rate and improve the prognosis. This review summarizes the influencing factors and high-risk populations for early and long-term rebleeding after endoscopic treatment of cirrhotic esophagogastric varices and special types of gastric varices.

Key words: Esophago-gas-tric fundal varices bleeding, Liver cirrhosis, Endoscopic treatment, Rebleeding, Risk factors
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