Abstract: Background　Bleeding gastroesophageal varices is a serious complication of portal hypertension in hepatic cirrhosis.The main treatments are endoscopic treatment and application of reducing-portal-pressure medicine.Somatostatin and terlipressin are classic reducing-portal-pressure medicines.Objective　To study the effect of early somatostatin and/or terlipressin combined with endoscopic treatment on patients with hepatic cirrhosis and bleeding gastroesophageal varices.Methods　From January 2010 to August 2018，a total of 173 patients with hepatic cirrhosis and bleeding gastroesophageal varices in Southern Medical University Affiliated Pingxiang Hospital were enrolled and randomly assigned into 4 groups according to 2×2 factorial design：placebo group；somatostatin group；terlipressin group；somatostatin+terlipressin group.Endoscopic treatment was performed after 48 hours of medicine treatment.Hemostasis time，recovery time of blood pressure，hemostatic effect，24 h hemostasis rate，48 h hemostasis rate，rebleeding rate and hemostasis rate within 2 weeks after endoscopic treatment，varicose veins alleviation effect，cost，cost-effectiveness ratio（C/E），ΔC/ΔE，sensitivity and incidences of adverse reactions of the 4 groups were analyzed.Results　The main effects of somatostatin and terlipressin on hemostasis time and recovery time of blood pressure were significant（P<0.001）．The interaction of somatostatin and terlipressin on hemostasis time and recovery time was not significant（P>0.05）．Compared with the placebo group，24 h hemostatic rate，48 h hemostasis rate，and the hemostasis rate within 2 weeks after endoscopic treatment of the somatostatin group，the terlipressin group，the somatostatin+terlipressin group significantly decreased（P<0.05）．There were significant differences between the efficacy of hemostasis and varicose veins between the 4 groups（Hc=10.914，P=0.012；Hc=9.708，P=0.021），but there were no significant differences between the efficacy of varicose veins of the somatostatin group，the terlipressin group and somatostatin+the terlipressin group（Hc=0.393，P=0.822；Hc=0.059，P=0.971）．Cost analysis showed that the cost of terliressin group and somatostatin+terlipressin group was higher than that of placebo group（P<0.05）．The cost-effectiveness ratio was calculated according to the 48 h hemostasis rate and the 2-week hemostasis rate.Compared with the placebo group，cost-effectiveness ratio of the somatostatin group significantly decreased，while increased significangly in the the terlipressin group and the somatostatin+terlipressin group（P<0.05）.In reference to somatostatin group，the incremental cost ratio ΔC/ΔE of the somatostatin+terlipressin group was lower than that of the terlipressin group（P<0.05）．Compared with the placebo group，the incidence of nausea significantly increased in the somatostatin group and the somatostatin+terlipressin group，and the incidence of abdominal pain significantly increased in the terlipressin group and the somatostatin+terlipressin group（P<0.05）．Compared with the placebo group，the incidences of intraoperative hemorrhage，fever，and ectopic embolization significantly decreased in the somatostatin group，the terlipressin group and the somatostatin+terlipressin group（P<0.05）.Conclusion　Early somatostatin or terlipressin combined with endoscopic treatment can effectively treat bleeding gastroesophageal varices in hepatic cirrhosis，and promote the varicose veins to allieviate.With the same effect，the cost of somatostatin is the lowest，followed by terlipressin，and somatostatin+terlipressin is the highest.Both somatostatin and terlipressin are safe for patients.There is no interaction between somatostatin and terlipressin，which can not further improve the efficacy.

Key words: Liver cirrhosis, Gastroesophageal varices, Bleeding, Somatostatin, Terlipressin

摘要： 背景　食管胃底静脉曲张破裂出血是肝硬化门脉高压的严重并发症，主要治疗方法是内镜处理和应用降低门脉压力药物；生长抑素和特利加压素是降门脉压力的经典药物。目的　研究早期生长抑素和/或特利加压素联合内镜处理治疗肝硬化食管胃底静脉曲张破裂出血的效果。方法　选择2010年1月—2018年8月南方医科大学附属萍乡医院收治的初次肝硬化食管胃底静脉曲张破裂出血住院患者173例为研究对象，患者采用2×2析因设计，随机分成四组：空白对照组、生长抑素组、特利加压素组、生长抑素+特利加压素组，药物治疗48 h后给予内镜治疗。分析四组止血时间、血压恢复时间、止血疗效、24 h止血率、48 h止血率、内镜治疗后2周内再出血率与止血率、曲张静脉减轻情况、成本、成本-效果比（C/E）、增量C/E（ΔC/ΔE）并进行敏感度分析，计算不良反应发生率。结果　生长抑素、特利加压素对止血时间、血压恢复时间主效应显著（P<0.001），生长抑素+特利加压素对止血时间、血压恢复时间交互作用不显著（P>0.05）。生长抑素组、特利加压素组、生长抑素+特利加压素组24 h止血率、48 h止血率、内镜治疗后2周内止血率低于空白对照组，内镜治疗后2周内再出血率低于空白对照组，差异有统计学意义（P<0.05）。四组止血疗效、静脉曲张疗效比较，差异有统计学意义（Hc=10.914，P=0.012；Hc=9.708，P=0.021），但生长抑素组、特利加压素组、生长抑素+特利加压素组止血疗效、静脉曲张疗效比较，差异无统计学意义（Hc=0.393，P=0.822；Hc=0.059，P=0.971）。成本分析结果显示，特利加压素组和生长抑素+特利加压素组成本较空白对照组增加（P<0.05）。与空白对照组比较，生长抑素组48 h、2周出血率C/E降低（P<0.05），特利加压素组和生长抑素+特利加压素组48 h、2周出血率C/E增加（P<0.05）。以生长抑素组为参考，生长抑素+特利加压素组ΔC/ΔE低于特利加压素组（P<0.05）。与空白对照组比较，生长抑素组和生长抑素+特利加压素组恶心发生率增加（P<0.05），特利加压素组和生长抑素+特利加压素组腹痛发生率增加（P<0.05）。与空白对照组比较，生长抑素组、特利加压素组和生长抑素+特利加压素组的术中出血、发热和异位栓塞发生率降低（P<0.05）。结论　早期生长抑素或特利加压素联合内镜处理均能有效治疗肝硬化食管胃底静脉曲张破裂出血，促进曲张静脉消失，在取得同等效果的情况下，生长抑素成本最低，特利加压素次之，生长抑素+特利加压素最高，且安全性较好，但生长抑素和特利加压素联用后没有交互作用，不能进一步提高疗效。

关键词: 肝硬化, 食管胃底静脉曲张, 出血, 生长抑素, 特利加压素