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首页> 外文期刊>Hepatology: Official Journal of the American Association for the Study of Liver Diseases >Primary Prophylaxis Against Gastric Variceal Bleeding: Is There a Sticky Solution at Last?
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Primary Prophylaxis Against Gastric Variceal Bleeding: Is There a Sticky Solution at Last?

机译：胃静脉曲张破裂出血的主要预防措施：最后是否有粘性溶液？

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In this randomized single center trial, 89 cirrhotic patients with GOV2 (eradicated esophageal varices) or IGV1 (both at least 10 mm size) not previously bled were selected for randomization over a 3 year period. Patients were randomized to: (1) Cyanoacrylate (n=30); (2) Propranolol (n=29); or (3) No treatment. There was complete obturation of GV in all patients after a mean of 1.6 +- 0.4 sessions. Propranolol was commenced at 20mg BD and titrated to aim for a heart rate of 55/ min (mean dose 140 mg). There was no discontinuation of propranolol due to side effects. Hepatic venous pressure gradient (HVPG) measurements were performed at baseline and after 1 year in all groups and within 24h of bleeding. Most patients had alcoholic or cryptogenic cirrhosis and GOV2 (85%) of 20mm median size. The median follow up time was 26 (3-34) months. There was significantly lower gastric variceal bleeding with cyanoacrylate in (10% versus 38% and 53% for propranolol and no treatment respectively). There was no difference in bleeding between propranolol and no treatment. There was a significant reduction in HVPG in the propranolol group (35% had HVPG response) and an increase in the other groups. HVPG at baseline and HVPG response did not predict bleeding. There was a significant difference in overall and bleeding related mortality in favor of the cyanoacrylate group compared with no treatment (7 versus 26%). No difference in mortality was seen between propranolol and the other groups.
机译：在该随机单中心试验中，选择了89例先前未出血的GOV2（根治性食管静脉曲张）或IGV1（均至少10 mm）的肝硬化患者，在3年内进行随机分组。患者随机分为：（1）氰基丙烯酸酯（n = 30）; （2）普萘洛尔（n = 29）;或（3）不治疗。在平均1.6±0.4次治疗后，所有患者的GV均完全闭塞。普萘洛尔开始于20 mg BD，并进行滴定，以使心率达到55 / min（平均剂量140 mg）。没有因副作用而停用普萘洛尔。所有组在出血后24小时内于基线时和1年后进行肝静脉压力梯度（HVPG）测量。大多数患者患有酒精性或隐源性肝硬化，中位大小为20mm的GOV2（85％）。中位随访时间为26（3-34）个月。氰基丙烯酸酯可显着降低胃静脉曲张破裂出血（普萘洛尔和未治疗分别为10％，38％和53％）。普萘洛尔与不进行治疗之间的出血无差异。普萘洛尔组的HVPG显着降低（对HVPG有35％的应答），其他组则升高。基线时的HVPG和HVPG反应不能预测出血。与未治疗相比，使用氰基丙烯酸酯组的总死亡率和出血相关死亡率有显着差异（7％vs 26％）。普萘洛尔与其他组的死亡率无差异。

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