摘要
目的探讨老年患者接受内镜治疗预防肝硬化食管胃静脉曲张再出血的疗效与安全性。方法回顾性收集2008年1月1日至2013年12月31日期间连续入住复旦大学附属中山医院，首次接受内镜治疗预防食管胃静脉曲张破裂再出血的肝硬化患者资料，随访至2014年11月16日或患者死亡。采用生存曲线描述分析患者再出血和生存情况，运用Log—Rank检验比较不同年龄组患者再出血率和死亡率，评估年龄对内镜预防再出血疗效和安全性的影响。结果共纳入患者574例，根据年龄分为A组（〈60岁，373例），B组（60～74岁，160例）和C组（〉74岁，41例），中位随访时间31．6个月，8周再出血率为10．28％（A组vsB组vsC组：9．92％VS10．63％vs12．20％），远期再出血率为40．07％（A组vsB组vsC组：38．34％vs42．50％vs46．34％），8周死亡率为4．01％（A组vsB组vsC组：3．49％vs5．00％vs4．88％），远期死亡率为16．20％（A组vsB组vsC组：11．80％vs23．13％vs29．27％）。组间两两比较显示8周死亡率、8周再出血率和远期再出血率差异均无统计学意义，但A组患者的远期死亡率低于B组（P〈0．001）及C组（P=0．001）。结论老年患者内镜预防肝硬化食管胃静脉曲张再出血安全有效，但远期生存较非老年患者差。由于老年患者的远期生存受众多因素影响，因此内镜预防再出血对长期预后的作用需要进一步研究加以明确。
Objective To explore the efficacy and safety of endoscopic therapy as secondary prophylaxis for gastroesophageal variceal hemorrhage in elderly patients with cirrhosis. Methods A retrospective study of consecutive cirrhotic patients receiving initial endoscopic therapy as secondary prophylaxis for variceal hemorrhage at Zhongshan Hospital, Fudan University from Jan. 1^st 2008 to Dec. 31^st 2013 was conducted. Survival and non-rebleeding rates were analyzed by Kaplan- Meier survival curves, and the Log-Rank test was used to determine the efficacy and safety in different age groups. Results A total of 574 cases with a mean follow-up period of 31.6 months were divided into three age groups： group A, patients under 60 years old （373 cases）, group B, patients from 60 to 74 years old （160 cases） and group C, patients older than 74 years old （41 cases）. The re-bleeding rate within 8 weeks was 10.28% （9.92% in the group A, 10.63% in the group B, and 12.20% in the group C, respectively）. The long-term re-bleeding rate was 40.07% （38.34% in the group A, 42.50% in the group B, and 46.34% in the group C, respectively）. The 8-week mortality rate was 4.01% （3.49% in the group A, 5.00% in the group B, and 4.88% in the group C, respectively）. The long-term mortality rate was 16.20% （11.80% in the group A, 23.13% in the group B, and 29.27% in the group C, respectively）. No significant differences were observed in the 8-week mortality rates, 8-week re-bleeding rates and long-term re-bleeding rates among the three groups. However,patients in group A had a significant lower long-term mortality rate compared to those of group B （P 〈 0.001）and group C （P=0.001）. Conclusion Endoscopic therapy as secondary prophylaxis for variceal hemorrhage in elderly cirrhotic patients is considered a safe and effective modality, although long term survival rates were less favorable compared to those of the non-elderly patients. Since the long term survival of elderly patients can be influenced by different factors,the long term outcome of endoscopic therapy as secondary prophylaxis variceal hemorrhage in elderly patients requires further investigation.
出处
《老年医学与保健》
CAS
2016年第4期223-226,共4页
Geriatrics & Health Care
基金
上海市科委科技创新项目:门静脉高血症诊治的多中心临床研究资助项目(15411950501)
国家科技支撑计划:临床研究方法学和共性技术示范应用研究(2013BAI09B14)
关键词
老年人
内镜治疗
再出血
肝硬化
疗效与安全性
Elderly patients
Endoscopic therapy
Re-bleeding
Cirrhosis
Efficacy and safety
