普萘洛尔三联小剂量对肝硬化门脉高压症近期疗效临床研究

目的:探讨普萘洛尔三联小剂量疗法对肝硬化门脉高压症(PHT)的近期疗效及其作用机制。方法:对68例肝硬化门脉高压症患者随机分为2组:34例三联治疗组和34例二联治疗组。三联治疗组采用口服普萘洛尔(propranolol)10mg,每日3次,螺内酯40mg,每日2次,新亚丹肖(5-单硝酸异山梨酯)20mg,每日2次(PIS方案)。二联治疗组患者采用口服普萘洛尔10mg,每日3次,螺内酯40mg,每日2次(PS方案)。两组疗程均为半年以上。用彩色多普勒超声仪(CDFI)检测两组治疗前、后门静脉系统血流动力学的变化。结果:用药1周后两组门静脉血流量(Qpv)、脾静脉血流量(Qsv)、门静脉血流速度(Vpv)和脾静血流速度(Vsv)均显著下降(P均<0.01);用药4周后Qpv、Qsv、门静脉内径(Dpv)、脾静脉内径(Dsv)均显著下降,与用药前比较差异有显著性(P均<0.01);经3个月的随访,临床上未见明显不良反应。PIS方案组PHT显著低于PS方案组,PHT出血率PIS方案组20.6%(7/34),显著低于PS方案组44.1%(15/34)(P<0.05)。病死率PS方案组为32.4%(11/34),PIS方案组为11.8%(4/34),PS方案组显著高于PIS方案组(P<0.05)。两组中ChildC级患者的再出血率和病死率差异无显著性(P>0.05)。用药12周后PIS方案组Qpv、Qsv、MAP显著低于PS方案组(P均<0.05)、HR显著高于PS组(P均<0.01)。结论:PIS

Clinical study of low-dose propranolol triple therapy for protal hypertension in patients with cirrhosis

Objective:To explore the effect mechanism and therapeutic effect of low-dose propranolol triple therapy for protal hypertension in patients with cirrhosis.Methods:68 patients with liver cirrhosis,including 48 males and 20 females,age from 35 to 84 years,were divided into two groups;the low-dose propranolol triple therapy group and the two drugs combination group,with 34 cases in each group.These patients in the triple therapy group were given propranolol 10 mg per os,Tid,isosorbide mononitrate 20 mg per os,Bid and spironolactone 40 ma per os,Bid(PIS).The other patients in two drugs combination group were given propranolol 10 mg per os,Tid and spironolactone 40 mg per os,Bid(PS).The course of treatment was half a year or more.The changes of protal venous hemodynamics in two groups were detected by color doppler ultrasonography before and after treatment.Results:In 1 week after treatment,the volume of blood flow and velocity of blood flow of portal and splenic vein in two groups decreased significantly(all P<0.01).In 4 weeks after treatment,the volume of blood flow and vein diameter of portal splenic vein in two group decreased significantly(all P<0.01).The follow-up was 12 weeks,the hemorrhage rate of portal hypertension in PIS and PS group was 20.6%(7/34) and 44.1%(15/34) respectively(P=0.038),the fatality rate was 11.8%(4/34) and 32.4%(11/34) respectively(P=0.022).There was no difference in the hemorrhage and fatality rate of Child C cirrhotic patients between two groups(P>0.05).In 12 weeks after treatment,compared with the PS group,the blood flow of portal and splenic vein and MBP in PIS group decreased significantly(P<0.05),while the heart increased significantly(P<0.01).Conclusion:Considering the effectiveness,the low-dose propranolol triple therapy has a greater therapeutic effect than the PS therapy on portal hypertension in cirrhotic patients.