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摘要：
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摘要：目的 分析生长抑素与特利加压素对乙型肝炎肝硬化食管胃静脉曲张出血（esophagogastric
variceal bleeding，EVB）患者的止血效果及对短期预后的影响。方法 采用回顾性队列研究，通过电
子病历系统收集2014年1月至2017年3月在解放军总医院第五医学中心诊断为乙型肝炎肝硬化上消化
道出血患者的临床资料、实验室数据及随访资料。根据纳入排除标准确定最终入组患者。根据使用
止血药的不同分为生长抑素组和特利加压素组，比较两组患者止血药的平均使用时间，24 h、48 h和
72 h停药率，住院期间再出血率、病死率及不良反应发生率。通过单因素及多因素Logistic回归分析
影响止血效果的独立有利因素。结果 本研究共纳入181例乙型肝炎肝硬化食管胃静脉曲张出血患者，
其中生长抑素组98例，特利加压素组83例。特利加压素组患者的止血药使用时间显著短于生长抑素
组[（62.01 ± 4.12）h vs（116.60 ± 4.75）h]，差异有统计学意义（t = 8.514，P ＜ 0.001）。生长抑素
组和特利加压素组患者24 h内止血药停药率[3.1%（3/98）vs 9.6%（8/83）]差异无统计学意义（χ 2 =
3.406，P = 0.065），特利加压素组患者48 h内停药率[48.2%（40/83）vs 7.1%（7/98）]和72 h内停药
率[74.7%（62/83）vs 14.3%（14/98）]均显著高于生长抑素组，差异有统计学意义（χ 2 = 39.392，P ＜
0.001；χ 2 = 67.335，P ＜ 0.001）。生长抑素组与特利加压素组患者住院期间病死率[11.2%（11/98）vs
3.6%（3/83）]和住院期间再出血率[11.2%（11/98）vs 6.0%（5/83）]差异无统计学意义（χ 2 = 3.647，
P = 0.056；χ 2 = 1.508，P = 0.219）。多因素Logistic回归分析表明特利加压素为影响72 h内止血效率
的独立有利因素（OR = 18.666，95%CI：8.214～42.419），P ＜ 0.001）。特利加压素组患者腹泻
[9.6%（8/83）vs 1.0%（1/98）]、腹痛[8.4%（7/83）vs 1.0%（1/98）]发生率显著高于生长抑素，差
异有统计学意义（χ 2 = 5.358，P = 0.021；χ 2 = 4.223，P = 0.040），而血压升高[3.6%（3/83）vs 0.0%
（0/98）]、顽固性低钠血症[2.4%（2/83）vs 0.0%（0/98）]及严重窦性心动过缓[1.2%（1/83）vs 0.0%
（0/98）]发生率的差异无统计学意义（P值分别为0.095、0.209、0.459）。结论 特利加压素在止血方
面具有明显优势，可作为乙型肝炎肝硬化EVB的一线治疗药物，有助于缩短临床住院时间，提高生存
率，改善预后。
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Abstract: Objective To analyze the effects of somatostatin and terlipressin on hemostasis and short-term
prognosis of hepatitis B related cirrhosis patients with esophagogastric varices bleeding (EVB). Methods The
clinical data, laboratory data and follow-up data of patients diagnosed as hepatitis B related cirrhosis with
EVB during hospitalization in the Fifth Medical Center of Chinese PLA General Hospital from January 2014
to March 2017 were collected in this retrospective cohort study. Final admission were based on the inclusion
and exclusion criteria. According to the different hemostatic drugs, the patients were divided into somatostatin
group and terlipressin group. The average medication duration of hemostatic drugs, 24 h, 48 h and 72 h
withdrawal rate, rebleeding rate, mortality and incidence of adverse reactions during hospitalization were
retrospectively analyzed and compared. Univariate and multivariate Logistic regression analysis were used
to analyze the independent factors affecting hemostasis. Results A total of 181 hepatitis B related cirrhosis
patients with EVB were enrolled, there were 98 cases in somatostatin group and 83 cases in terlipressin group.
The medication duration of patients in terlipressin group was significantly shorter than that in somatostatin
group [(62.01 ± 4.12) h vs (116.60 ± 4.75) h], the difference was statistically significant (t = 8.514, P ＜
0.001). There was no significant difference on withdrawal rate of hemostatic drugs at 24 h of patients in
somatostatin group and terlipressin group [3.1% (3/98) vs 9.6% (8/83), χ 2 = 3.406, P = 0.065]. The withdrawal
rate of hemostatic drugs in teripressin group were significantly higher than those in omatostatin group at 48 h
[48.2% (40/83) vs 7.1% (7/98)] and 72 h [74.7% (62/83) vs 14.3% (14/98)], the differences were statistically
significant (χ 2 = 39.392, P ＜ 0.001; χ 2 = 67.335, P ＜ 0.001). There were no statistically significant
differences of mortality [11.2% (11/98) vs 3.6% (3/83)] and rebleeding rate [11.2% (11/98) vs 6.0% (5/83)] of
patients in somatostatin group and terlipressin group (χ 2 = 3.647, P = 0.056; χ 2 = 1.508, P = 0.219). Multivariate
Logistic regression analysis showed that terlipressin was an independent favorable factor affecting hemostasis
efficiency within 72 hours (OR = 18.666, 95%CI: 8.214～42.419, P ＜ 0.001). The incidence of diarrhea [9.6%
(8/83) vs 1.0% (1/98)] and abdominal pain [8.4% (7/83) vs 1.0% (1/98)] in terlipressin group were higher
than those in somatostatin group, and the differences were statistically significant (χ 2 = 5.358, P = 0.021; χ 2 =
4.223, P = 0.040). The incidence of hypertension [3.6% (3/83) vs 0.0% (0/98)], persistent hyponatremia [2.4%
(2/83) vs 0.0% (0/98)] and severe sinus bradycardia [1.2% (1/83) vs 0.0% (0/98)] of patients in somatostatin
group and terlipressin group had no statistical difference (P = 0.095, 0.209, 0.459). Conclusions Terlipressin
has obvious advantages in hemostasis and can be used as a first-line choice for EVB of hepatitis B related
cirrhosis, which can decrease the clinical hospitalization time, improve the survival rate and the prognosis.
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