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

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=2.338,P=0.024),但患者未出现明显低血压的不良反应;2组患者胆红素、血肌酐和尿素氮在治疗前后无明显升高,亦无腹水生成或加重的趋势。结论本研究提示在短期内卡维地洛降低HVPG的作用较普萘洛尔显著,且无明显不良反应;其用于肝硬化门静脉高压的治疗是安全有效的。

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

Objective Toinvestigatethedifferencesbetweencarvedilolandpropranololinthedegreeofhepaticvenouspressuregradient (HVPG)reduction,response rate,and adverse events in patients with cirrhotic portal hypertension,and to evaluate the efficacy and safety of carvedilolinreducingportalveinpressure.Methods Sixty-fourpatientswithcirrhoticportalhypertensionwhowerediagnosedandtreatedin 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.Measure-ments 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 testorFisher′sexact.Results HVPGwasreducedsignificantlyinbothcarvedilolgroupandpropranololgroup,withdegreesof(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,respec-tively,with no significant difference between the two groups (χ2 =1.324,P=0.250).The carvedilol group had a significantly more reduc-tion in mean arterial pressure (MAP)than the propranolol group (t=2.338,P=0.024),but the patients did not experience the adverse e-vent of hypotension.The levels of bilirubin,serum creatinine,and urea nitrogen did not change significantly before and after treatment,and therewasnotendencyofascitesformationoraggravation.Conclusion Thisrandomizedstudysuggeststhatwithinashortperiodoftime, 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.