The portal pressure response to beta-blockade is greater in cirrhotic patients without varices than in those with varices.
The portal pressure response to beta-blockade is greater in cirrhotic patients without varices than in those with varices.
复制标题
无静脉曲张的肝硬化患者对β受体阻滞剂的门静脉压力反应比有静脉曲张的患者更大。
DOI：
10.1053/gast.1997.v112.pm9178694
复制
发表时间：
1997
期刊：
影响因子：
29.4
通讯作者：
Groszmann,RJ
中科院分区：
文献类型：
--
作者：
Escorsell,A;Ferayorni,L;Bosch,J;García-Pagán,JC;García-Tsao,G;Grace,ND;Rodés,J;Groszmann,RJ
背景与目的非选择性β受体阻滞剂能有效降低门静脉压力。然而，这种有益的影响是高度可变的，可能取决于门静脉系统侧支化的程度。本研究的目的是比较门静脉压力反应与噻吗洛尔，一种非选择性β受体阻滞剂，在肝硬化患者和无varices. METHODS门静脉和全身血流动力学测定之前和之后，单次口服剂量的噻吗洛尔10毫克在50例肝硬化门静脉高压症，15例有食管静脉曲张，35例无食管静脉曲张。在所有患者中，舒伐他汀能显著降低门静脉压力（平均降低20% ± 13%; P < 0.0001）。无静脉曲张患者的肝静脉压差下降幅度（-24% ± 14%）大于有静脉曲张患者（-12% ± 8%）（P < 0.01）。12例无静脉曲张且基线压差<12 mm Hg的患者中有7例（58%）实现了肝静脉压差<12 mm Hg的降低，但15例静脉曲张患者中仅3例（20%）实现了肝静脉压差<12 mm Hg的降低。结论：司他洛尔能有效降低静脉曲张患者的门静脉压力，对无静脉曲张的患者作用更明显，这表明，在静脉曲张发生之前的早期阶段使用非选择性β受体阻滞剂治疗门静脉高压症将更有效。（胃肠病学1997年6月;112（6）：2012-6）
BACKGROUND & AIMSNonselective beta-blockers are effective in reducing portal pressure in cirrhotic patients. However, this beneficial effect is highly variable and may depend on the extent of portal system collateralization. The aim of this study was to compare portal pressure response with timolol, a nonselective beta-blocker, in cirrhotic patients with and without varices.METHODSPortal and systemic hemodynamics were measured before and after a single oral dose of 10 mg of timolol in 50 patients with cirrhosis and portal hypertension, 15 with and 35 without esophageal varices.RESULTSTimolol significantly decreased portal pressure in all patients (mean reduction, 20% +/- 13%; P < 0.0001). The reduction in hepatic venous pressure gradient was greater in patients without varices (-24% +/- 14%) than in those with varices (-12% +/- 8%) (P < 0.01). A decrease in the hepatic venous pressure gradient of <12 mm Hg was achieved in 7 of 12 (58%) patients without varices and a baseline pressure gradient of <12 mm Hg, but only in 3 of 15 patients with varices (20%) (P < 0.01).CONCLUSIONSTimolol is effective in reducing portal pressure in cirrhotic patients, more so in patients without varices, suggesting that nonselective beta-blockers will be more effective in the treatment of portal hypertension when administered at early stages, before the development of varices. (Gastroenterology 1997 Jun;112(6):2012-6)