Risk factors for rebleeding after endoscopic selective variceal devascularization in patients with hepatitis B cirrhosis and acute variceal bleeding
10.3969/j.issn.1001-5256.2021.11.017
- VernacularTitle:内镜下精准食管胃静脉曲张断流术治疗乙型肝炎肝硬化伴急性静脉曲张出血患者再出血的危险因素分析
- Author:
Jiali MA
1
;
Yu JIANG
1
;
Julong HU
1
;
Zhenglin AI
1
;
Lingling HE
1
;
Yuling ZHOU
1
;
Xiuxia LIANG
1
;
Yijun LIN
1
;
Hongshan WEI
1
;
Ping LI
1
Author Information
1. Department of Gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
- Publication Type:Original articles_Liver fibrosis and liver cirrhosis
- Keywords:
Liver Cirrhosis;
Esophageal and Gastric Varices;
Hemorrhage;
Risk Factors
- From:
Journal of Clinical Hepatology
2021;37(11):2569-2574
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the rebleeding rate after endoscopic selective variceal devascularization (ESVD) and the predictive factors for rebleeding in patients with hepatitis B cirrhosis and esophageal variceal bleeding (EVB). Methods The patients with hepatitis B cirrhosis and EVB who attended Beijing Ditan Hospital, Capital Medical University, from October 2010 to December 2019 and underwent ESVD for the first time were enrolled, and a total of 442 patients were screened out based on inclusion and exclusion criteria. Routine clinical indices, laboratory markers, imaging findings, and endoscopic findings were compared between patients, and the patients were followed up to observe rebleeding. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to describe rebleeding and survival status, and a Cox regression analysis was used to determine the independent risk factors for variceal rebleeding. Results The 1-, 2-, 3-, 4-, and 5-year cumulative rebleeding rates after first ESVD treatment were 25.11%, 33.94%, 39.82%, 42.08%, and 45.02%, respectively. The univariate analysis showed that age, systolic pressure, duration of antiviral therapy ≥1 year, ascites, white blood cell count, neutrophil, and direct bilirubin were associated with rebleeding (all P < 0.05), and the multivariate analysis showed that duration of antiviral therapy ≥1 year (hazard ratio [ HR ]=0.504, 95% confidence interval [ CI ]: 0.357-0.711, P < 0.001) and ascites ( HR =1.424, 95% CI : 1.184-1.714, P < 0.001) were independent influencing factors for variceal rebleeding. Conclusion ESVD has a low rebleeding rate in the treatment of hepatitis B cirrhosis with EVB, and presence of ascites and a short duration of antiviral therapy are independent risk factors for rebleeding after treatment.
