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益生菌在食管胃静脉曲张破裂出血初级预防中的作用

张群 牛帅帅 王宪波

张群, 牛帅帅, 王宪波. 益生菌在食管胃静脉曲张破裂出血初级预防中的作用[J]. 临床肝胆病杂志, 2021, 37(2): 331-335. DOI: 10.3969/j.issn.1001-5256.2021.02.017
引用本文: 张群, 牛帅帅, 王宪波. 益生菌在食管胃静脉曲张破裂出血初级预防中的作用[J]. 临床肝胆病杂志, 2021, 37(2): 331-335. DOI: 10.3969/j.issn.1001-5256.2021.02.017
ZHANG Q, NIU SS, WANG XB. Role of probiotics in primary prevention of esophagogastric variceal bleeding [J]. J Clin Hepatol, 2021, 37(2): 331-335. DOI: 10.3969/j.issn.1001-5256.2021.02.017
Citation: ZHANG Q, NIU SS, WANG XB. Role of probiotics in primary prevention of esophagogastric variceal bleeding [J]. J Clin Hepatol, 2021, 37(2): 331-335. DOI: 10.3969/j.issn.1001-5256.2021.02.017

益生菌在食管胃静脉曲张破裂出血初级预防中的作用

DOI: 10.3969/j.issn.1001-5256.2021.02.017
基金项目: 

北京市科学技术委员会资助 Z191100006619033

首都卫生发展科研专项 首发2018-1-2172

国家中医药管理局区域中医(肝病)诊疗中心建设项目 2019-3-18

国家中医药管理局重大疑难疾病中西医临床协作试点项目 2018-6-4

详细信息
    作者简介:

    张群(1991—),女,主要从事中西医结合肝病方面的研究

    通讯作者:

    王宪波,wangxianbo638@163.com

  • 利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突,特此声明。
  • 作者贡献声明:王宪波负责课题设计;张群、牛帅帅参与数据收集,数据分析;张群负责论文撰写及修改;王宪波负责拟定写作思路,指导撰写文章并最后定稿。
  • 中图分类号: R575.2

Role of probiotics in primary prevention of esophagogastric variceal bleeding

  • 摘要:   目的  探讨益生菌对肝硬化食管胃静脉曲张患者1年内出血风险的影响。  方法  选取2008年2月—2017年2月于首都医科大学附属北京地坛医院住院且随访时间超过1年的肝硬化食管胃静脉曲张患者692例,其中346例患者在1年的随访期内接受了益生菌治疗(益生菌组)队列,随后采用1:1倾向评分的方法通过校正Child-Pugh分级、静脉曲张分度、红色征为其匹配346例未接受益生菌治疗的患者(非益生菌组)。所有入选患者均按照指南推荐的初级预防策略进行管理,而益生菌队列则在此基础上辅助了益生菌治疗,观察两个队列1年内静脉曲张出血发生率的差异。计量资料两组间比较采用t检验或Mann-Whitney U检验;计数资料两组间比较采用χ2检验;食管胃静脉曲张破裂出血影响因素的筛选采用向后的Cox单因素和多因素回归分析;Kaplan-Meier对两个队列EVB的累积发生率进行分析,并用log-rank进行比较。  结果  益生菌治疗是肝硬化食管胃静脉曲张破裂出血的独立保护因子(校正危险比=0.510,95%CI:0.299~0.870,P=0.013)。共61例患者在1年的随访期内发生了EVB事件,其中益生菌组23例,非益生菌组38例, 益生菌组1年内EVB的累积发生率明显低于非益生菌组(6.6% vs 11.0%,χ2=4.045,P=0.042),且益生菌组基线时至发生出血的中位时间晚于非益生菌组[137.0(85.0~258.0)d vs 123.0(72.5~206.5)d, Z=-1.101, P=0.271]。  结论  益生菌能有效降低肝硬化食管胃静脉曲张患者1年内出血事件的发生率,并有延缓出血事件发生时间的趋势。
  • 图  1  两组1年EVB累积发生率Kaplan-Meier分析曲线

    图  2  两组患者出血时间间隔小提琴图

    表  1  两组患者基线特征比较

    项目 所有患者
    (n=692)
    益生菌组
    (n=346)
    非益生菌组
    (n=346)
    统计值1) P1)
    年龄(岁) 52.0 (44.0~60.0) 52.0 (44.0~60.0) 52.0 (45.0~59.0) Z=-0.137 0.891
    男/女(例) 477/215 240/106 237/109 χ2=0.061 0.805
    病因(HBV/HCV/ALD/其他,例) 476/62/79/75 236/29/43/38 240/33/36/37 χ2=0.925 0.819
    腹水(有/无,例) 406/286 205/141 201/145 χ2=0.095 0.757
    细菌感染(有/无,例) 141/551 74/272 67/279 χ2=0.436 0.509
    肝性脑病(有/无,例) 30/662 19/327 11/335 χ2=2.230 0.135
    静脉曲张位置(食管/胃/同时,例) 382/25/285 191/11/144 191/14/141 χ2=0.392 0.822
    静脉曲张分度(轻/中/重,例) 324/180/188 164/87/95 160/93/93 χ2=0.271 0.873
    红色征(有/无,例) 228/464 109/237 119/227 χ2=0.654 0.419
    ALT(U/L) 36.6 (24.4~63.6) 36.2 (25.0~62.0) 37.7 (24.1~66.7) Z=-0.663 0.508
    AST(U/L) 49.8 (33.1~82.9) 48.7 (32.1~77.0) 51.2 (34.0~90.7) Z=-1.194 0.232
    GGT(U/L) 53.3 (29.0~111.2) 52.4 (28.8~109.4) 54.0 (30.3~113.1) Z=-0.376 0.707
    TBil(μmol/L) 29.3 (18.8~46.6) 27.6 (17.4~44.8) 30.1 (19.7~49.8) Z=-2.154 0.031
    Alb(g/L) 31.9 (27.7~37.0) 32.0 (27.8~36.7) 31.8 (27.7~37.3) Z=-0.123 0.902
    WBC(×109/L) 3.3 (2.6~4.5) 3.3 (2.6~4.4) 3.3 (2.5~4.6) Z=-0.435 0.664
    RBC(×1012/L) 3.7±0.7 3.7±0.7 3.7±0.7 t=0.236 0.813
    NLR 1.9 (1.3~2.8) 1.8 (1.3~2.8) 1.9 (1.3~2.7) Z=-0.421 0.673
    Hb(g/L) 120.2 (106.4~133.6) 119.0 (105.8~133.3) 121.0 (108.0~133.7) Z=-1.069 0.285
    HCT(%) 35.1 (31.2~39.1) 34.9 (31.2~39.5) 35.5 (31.3~38.9) Z=-0.666 0.505
    PLT(×109/L) 61.5 (44.0~85.0) 61.7 (45.0~88.1) 61.5 (43.3~82.9) Z=-0.405 0.685
    Cr(μmol/L) 64.0 (55.0~73.7) 64.0 (56.0~74.3) 63.6 (55.0~72.6) Z=-1.467 0.142
    Glu(mmol/L) 5.5 (4.9~6.8) 5.5 (4.9~6.8) 5.5 (4.9~7.0) Z=-0.402 0.688
    PTA(%) 66.0 (54.5~78.0) 67.0 (55.0~79.0) 64.7 (54.0~77.0) Z=-1.213 0.225
    INR 1.1 (1.1~1.4) 1.2 (1.1~1.3) 1.2 (1.1~1.4) Z=-0.098 0.922
    脾脏厚度(mm) 48.0 (42.0~55.8) 48.0 (42.0~56.0) 48.0 (42.0~55.3) Z=-0.134 0.894
    门静脉宽度(mm) 12.0 (11.0~13.0) 12.0 (11.0~13.0) 12.0 (11.0~13.0) Z=-1.005 0.316
    Child-Pugh分级(A/B/C,例) 214/345/133 105/175/66 109/170/67 χ2=0.155 0.926
    初级预防
      NSBB(有/无,例) 19/673 11/335 8/338 χ2=0.487 0.485
      EVL(有/无,例) 86/606 45/301 41/305 χ2=0.212 0.645
    注:1)益生菌组与非益生菌组进行比较。ALD,酒精性肝病;NLR,中性粒细胞淋巴细胞比值;Hb,血红蛋白;HCT,红细胞压积;Cr,肌酐;Glu,葡萄糖。
    下载: 导出CSV

    表  2  EVB影响因素Cox回归分析

    因素 单因素分析 多因素分析
    aHR(95%CI) P aHR(95%CI) P
    性别(女性=0;男性=1) 1.890(1.005~3.553) 0.048
    病因(HBV=1;HCV=2;ALD=3;其他=4) 0.302(0.151~0.603) 0.001 0.357 (0.183~0.695) 0.002
    腹水(无=0;有=1) 2.192(1.224~3.926) 0.008
    静脉曲张位置(食管=1;胃=2;食管和胃=3) 1.581(1.211~2.065) 0.001
    静脉曲张分度(轻度=1;中度=2;重度=3) 2.111(1.547~2.879) <0.001
    红色征(无=0;有=1) 4.832(2.810~8.308) <0.001 3.997(2.260~7.071) <0.001
    GGT 1.001(1.000~1.002) 0.013 1.001(1.001~1.002) <0.001
    Alb 0.958(0.918~1.000) 0.049
    RBC 0.628(0.446~0.883) 0.007
    NLR 1.092(1.029~1.159) 0.003
    Hb 0.984(0.975~0.993) 0.001 0.984(0.974~0.994) 0.001
    HCT 0.950(0.919~0.981) 0.002
    脾脏厚度 1.044(1.023~1.066) <0.001 1.034(1.011~1.058) 0.004
    益生菌治疗(无=0;有=1) 0.587(0.350~0.986) 0.044 0.510(0.299~0.870) 0.013
    下载: 导出CSV
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  • 收稿日期:  2020-08-10
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