Development of hyperdynamic circulation and response to β‐blockers in compensated cirrhosis with portal hypertension
Development of hyperdynamic circulation and response to β‐blockers in compensated cirrhosis with portal hypertension
复制标题
代偿性肝硬化门脉高压患者高动力循环的发展和对 β 受体阻滞剂的反应
作者：
C. Villanueva;A. Albillos;J. Genescà;J. Abraldes;J. Calleja;C. Aracil;R. Bañares;R. Morillas;M. Poca;B. Peñas;S. Augustin;J. García;O. Pavel;J. Bosch
非选择性β受体阻滞剂对肝硬化和大静脉曲张患者预防出血有用，但对代偿性肝硬化和门脉高压（PHT）患者预防静脉曲张发展无效。这表明PHT的进化阶段可能影响对β受体阻滞剂的反应。为了描述代偿性肝硬化PHT各阶段的血流动力学特征以及各阶段对β受体阻滞剂的反应，我们进行了一项前瞻性、多中心（三级保健机构）的横断面研究。对273例代偿性肝硬化患者在静脉注射心得安（0.15 mg/kg）前后的肝静脉压梯度（HVPG）和全身血流动力学进行了测量：194例HVPG≥10 mm Hg（临床显著性PHT [CSPH]），无静脉曲张（n = 80）或小静脉曲张（n = 114）， 79例HVPG bb0.5和<10 mm Hg（亚临床PHT）。与亚临床PHT患者相比，CSPH患者肝脏硬度更高（P < 0.001），终末期肝病模型评分更差（P < 0.001），超声显示门静脉侧枝（P = 0.01）和脾肿大（P = 0.01）更多，血小板计数更低（P < 0.001）。CSPH患者全身血管阻力较低（1336±423比1469±335达因·s·cm‐5，P < 0.05），心脏指数较高（3.3±0.9比2.8±0.4 L/min/m2, P < 0.01）。服用普纳洛尔后，两组患者的HVPG均显著下降，但CSPH患者的下降幅度更大（- 16±12% vs - 8±9%,P < 0.01）。与基线相比，69%的CSPH患者HVPG下降≥10%，而35%的亚临床PHT患者HVPG下降≥20% (P < 0.001)，分别为40%和13% （P = 0.001）。结论：与CSPH患者相比，亚临床PHT患者急性β阻断后高动力循环减少，门静脉压降低明显降低，提示β阻断剂比早期更适合预防CSPH患者肝硬化失代偿。(肝脏病学63:197 2016;206)
Nonselective β‐blockers are useful to prevent bleeding in patients with cirrhosis and large varices but not to prevent the development of varices in those with compensated cirrhosis and portal hypertension (PHT). This suggests that the evolutionary stage of PHT may influence the response to β‐blockers. To characterize the hemodynamic profile of each stage of PHT in compensated cirrhosis and the response to β‐blockers according to stage, we performed a prospective, multicenter (tertiary care setting), cross‐sectional study. Hepatic venous pressure gradient (HVPG) and systemic hemodynamic were measured in 273 patients with compensated cirrhosis before and after intravenous propranolol (0.15 mg/kg): 194 patients had an HVPG ≥10 mm Hg (clinically significant PHT [CSPH]), with either no varices (n = 80) or small varices (n = 114), and 79 had an HVPG >5 and <10 mm Hg (subclinical PHT). Patients with CSPH had higher liver stiffness (P < 0.001), worse Model for End‐Stage Liver Disease score (P < 0.001), more portosystemic collaterals (P = 0.01) and splenomegaly (P = 0.01) on ultrasound, and lower platelet count (P < 0.001) than those with subclinical PHT. Patients with CSPH had lower systemic vascular resistance (1336 ± 423 versus 1469 ± 335 dyne · s · cm‐5, P < 0.05) and higher cardiac index (3.3 ± 0.9 versus 2.8 ± 0.4 L/min/m2, P < 0.01). After propranolol, the HVPG decreased significantly in both groups, although the reduction was greater in those with CSPH (‐16 ± 12% versus ‐8 ± 9%, P < 0.01). The HVPG decreased ≥10% from baseline in 69% of patients with CSPH versus 35% with subclinical PHT (P < 0.001) and decreased ≥20% in 40% versus 13%, respectively (P = 0.001). Conclusion: Patients with subclinical PHT have less hyperdynamic circulation and significantly lower portal pressure reduction after acute β‐blockade than those with CSPH, suggesting that β‐blockers are more suitable to prevent decompensation of cirrhosis in patients with CSPH than in earlier stages. (Hepatology 2016;63:197–206)
DOI：
10.1152/ajpgi.00336.2005
发表时间：
2006-05-01
影响因子：
4.5
作者：
Abraldes, JG;Iwakiri, Y;Groszmann, RJ
通讯作者：
Groszmann, RJ
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。
影响因子：
29.4
作者：
Escorsell,A;Ferayorni,L;Bosch,J;García-Pagán,JC;García-Tsao,G;Grace,ND;Rodés,J;Groszmann,RJ
通讯作者：
Groszmann,RJ
影响因子：
29.4
作者：
Ripoll, Cristina;Groszmann, Roberto;Bosch, Jaime
通讯作者：
Bosch, Jaime