卡维地洛与普萘洛尔降低肝硬化门静脉高压患者肝静脉压力梯度效果的对比分析

李晶; 孙东杰; 王广川; 冯华; 史永军; 张春清

doi:10.3969/j.issn.1001-5256.2016.01.021

卡维地洛与普萘洛尔降低肝硬化门静脉高压患者肝静脉压力梯度效果的对比分析

DOI: 10.3969/j.issn.1001-5256.2016.01.021

山东大学附属省立医院消化科

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中图分类号: R657.34
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出版历程
- 收稿日期: 2015-05-13
- 出版日期: 2016-01-20

A comparative analysis of carvedilol and propranolol in hepatic venous pressure gradient reduction in patients with cirrhotic portal hypertension

Department of Gastroenterology,Shandong Provincial Hospital Affiliated to Shandong University

摘要

摘要: 目的探讨卡维地洛和普萘洛尔降低肝硬化门静脉高压患者肝静脉压力梯度（HVPG）的幅度、应答率以及用药后不良反应的差异,对卡维地洛降低门静脉压力的有效性和安全性进行评价。方法收集2010年10月-2012年1月在山东大学附属省立医院确诊的64名肝硬化门静脉高压患者,随机分为2组:普萘洛尔组（n=33）和卡维地洛组（n=31）,根据血压和心率调整剂量,疗程7 d,均于治疗前后行HVPG测定及肝肾功能指标检测,比较2组患者HVPG降低的幅度及应答率,并观察患者低血压、腹水、肾损伤等不良反应的发生情况。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验或Fisher精确概率法。结果卡维地洛组和普萘洛尔组的HVPG均明显降低,降低幅度分别为（28.30±22.19）%和（12.38±24.09）%,其中卡维地洛组降低更明显,差异有统计学意义（t=0.223 4,P=0.032）。2组应答率分别为:卡维地洛组56.7%（17/30）,普萘洛尔组41.9%（13/31）,2组差异无统计学意义（χ2=1.324,P=0.250）。卡维地洛组平均动脉压的降低较普萘洛尔组明显,差异有统计学意义（t=2...
- 肝硬化 /
- 高血压,门静脉 /
- 普萘洛尔 /
- 卡维地洛
Abstract: Objective To investigate the differences between carvedilol and propranolol in the degree of hepatic venous pressure gradient( HVPG) reduction,response rate,and adverse events in patients with cirrhotic portal hypertension,and to evaluate the efficacy and safety of carvedilol in reducing portal vein pressure. Methods Sixty- four patients with cirrhotic portal hypertension who were diagnosed and treated in Shandong Provincial Hospital from October 2010 to January 2012 were selected and randomized into propranolol group( n = 33) and carvedilol group( n = 31). The dose of drugs was adjusted according to blood pressure and heart rate,and the course of treatment was 7 days. Measurements of HVPG and liver and renal function indices were performed before and after treatment,and the degree of HVPG reduction and response rate were compared between the two groups. The incidence of adverse events such as hypotension,ascites,and renal injury in the two groups was observed. Comparison of continuous data between the two groups was made by t test,and comparison of categorical data was made by chi- square test or Fisher's exact. Results HVPG was reduced significantly in both carvedilol group and propranolol group,with degrees of( 28. 30 ±22. 19) % and( 12. 38 ± 24. 09) %,respectively,and the reduction in the carvedilol group was significantly greater / higher / larger( t =0. 223 4,P = 0. 032). The response rate was 56. 7%( 17 /30) and 41. 9%( 13 /31) in the carvedilol group and propranolol group,respectively,with no significant difference between the two groups( χ2= 1. 324,P = 0. 250). The carvedilol group had a significantly more reduction in mean arterial pressure( MAP) than the propranolol group( t = 2. 338,P = 0. 024),but the patients did not experience the adverse event of hypotension. The levels of bilirubin,serum creatinine,and urea nitrogen did not change significantly before and after treatment,and there was no tendency of ascites formation or aggravation. Conclusion This randomized study suggests that within a short period of time,carvedilol is more effective than propranolol in reducing HVPG and has no obvious adverse effects. Carvedilol is safe and effective in the treatment of cirrhotic portal hypertension.
- liver cirrhosis /
- hypertension,portal /
- propranolol /
- carvedilol

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参考文献(19)

[1]GARCIA-TSAO G,SANYAL AJ,GRACE ND,et al.Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis[J].Hepatology,2007,46(3):922-937.

[2]XU XQ,LI M.Influence of red sage and propranolol on portal hypertension rats'pressure,liver fibrosis and gastric-intestinal hormone[J].J Zhejiang Univ Tradit Chin Med,2010,34(3):312-313.(in Chinese)徐晓琦,李民.丹参、心得安对门静脉高压症大鼠门静脉压力、肝纤维化指标及胃肠激素的影响[J].浙江中医药大学学报,2010,34(3):312-313.

[3]LYU GX,ZHANG T,ZHOU ND,et al.Effects of carvedicol on plasma norepinephrine and myocardial IL-6 production in murine model with the coxsackievirus B3-induced viral myocarditis[J].Chin J Clin Pharmacol Ther,2013,18(12):1332-1337.(in Chinese)吕干新,张腾,周娜丹,等.卡维地洛对柯萨奇病毒B3感染小鼠儿茶酚胺及IL-6表达水平的影响[J].中国临床药理学与治疗学,2013,18(12):1332-1337.

[4]BOSCH J.Carvedilol for portal hypertension in patients with cirrhosis[J].Hepatology,2010,51(6):2214-2218.

[5]TSOCHATZIS EA,TRIANTOS CK,BURROUGHS AK.Gastrointestinal bleeding:carvedilol-the best beta-blocker for primary prophylaxis?[J].Nat Rev Gastroenterol Hepatol,2009,6(12):692-694.

[6]LA-MURA V,ABRALDES JG,RAFFA S,et al.Prognostic value of acute hemodynamic response to i.v.propranolol in patients with cirrhosis and portal hypertension[J].J Hepatol,2009,51(2):279-287.

[7]GE PS,RUNYON BA.The changing role of beta-blocker therapy in patients with cirrhosis[J].J Hepatol,2014,60(3):643-653.

[8]TRIPATHI D,HAYES PC.Beta-blockers in portal hypertension:new developments and controversies[J].Liver International,2014,34(5):655-667.

[9]DRASTICH P,LATA J,PETRTYL J,et al.Endoscopic variceal band ligation compared with propranolol for prophylaxis of first varical bleeding[J].Ann Hepatol,2011,10(6):142-149.

[10]LIANG CL,FAN XM.Effects of carvedilol on hepatic fibrosis[J].Chin J Gen Prac,2010,8(10):1211-1212.(in Chinese)梁春丽,樊晓明.卡维地洛抗肝纤维化的试验研究[J].中华全科医学,2010,8(10):1211-1212.

[11]BANARES R,MOITINHO E,MATILLA A,et al.Randomized comparison of long-term carvedilol and propranolol administration in the treatment of portal hypertension in cirrhosis[J].Hepatology,2002,36(6):1367-1373.

[12]HOBOLTH L,BENDTSEN F,HANSEN EF,et al.Effects of carvedilol and propranolol on circulatory regulation and oxygenation in cirrhosis:a randomised study[J].Dig Liver Dis,2014,46(3):251-256.

[13]TRIPATHI D,FERGUSON JW,KOCHAR N,et al.Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed[J].Hepatology,2009,50(3):825-833.

[14]HEMSTREET BA.Evaluation of carvedilol for the treatment of portal hypertension[J].Pharmacotherapy,2004,24(1):94-104.

[15]HEMANDEZ-GEA V,ARACIL C,COLOMO A,et al.Development of ascites in compensated cirrhosis with severe portal hypertension treated withβ-blockers[J].Am J Gastroenterol,2012,107(3):418-427.

[16]SERSTE T,MELOT C,FRANCOZ C,et al.Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites[J].Hepatology,2010,52(3):1017-1022.

[17]SERSTE T,FRANCOZ C,DURAND F,et al.Beta-blockers cause paracentesis-induced circulatory dysfunction in patients with cirrhosis and refractory ascites:a cross-over study[J].J Hepatol,2011,55(4):794-799.

[18]BRUHA R,VITEK L,PETRTYL J,et al.Effect of carvedilol on portal hypertension depends on the degree of endothelial activation and inflammatory changes[J].Scand J Gastroenterol,2006,41(12):1454-1463.

[19]REIBERGER T,ULBRICH G,FERLITSCH A,et al.Carvedilol for primary prophylaxis of variceal bleeding in cirrhotic patients with haemodynamic non-response to propranolol[J].Gut,2013,62(11):1634-1641.

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