J Hepatology: β受体阻滞剂的短期血流动力学影响会对失代偿性肝硬化患者的生存产生负面作用

2020-10-06 MedSci原创 MedSci原创

肝硬化失代偿的最严重结果会导致患者死亡,预防死亡可视为肝硬化失代偿患者的主要目标。

        肝硬化失代偿的最严重结果会导致患者死亡,预防死亡可视为肝硬化失代偿患者的主要目标。非选择性β受体阻滞剂(NSBBs)可有效预防静脉曲张破裂出血并降低死亡率。但是,β受体阻滞剂对动脉压和/或心脏功能的影响是否可以抵消晚期肝硬化中降低门脉压力的益处尚存争议。因此,本项研究旨在评估β受体阻滞剂对肝硬化失代偿患者的存活时间以及全身血流动力学变化的影响。

 

         研究人员将患有肝硬化和高危食管静脉曲张患者纳入本项研究,根据失代偿的存在与否(有或没有明显脑病的腹水)进行分组。在开始使用β受体阻滞剂之前以及在治疗1至3个月后再次进行全身和肝血流动力学测量,最后统计分析β受体阻滞剂对肝硬化失代偿患者的存活时间的影响。

 

        本项研究共纳入403位患者(190位失代偿和213位失代偿)。在使用β受体阻滞剂的情况下,失代偿的患者门静脉压力降低较低(10±18% VS 15±12%;p < 0.05),心率和CO降低更大( p < 0.001)(17±15% VS 10±21%;p < 0.01)。在失代偿性肝硬化患者中,死亡患者与β受体阻滞剂相比,CO下降幅度大于存活者(21±14% VS 15±16%; p < 0.05)和β受体阻滞剂下的CO通过竞争风险回归分析独立预测死亡,具有良好的诊断准确性(C指数0.74; 95%CI 0.66-0.83)。与CO≥5L / min相比,失代偿的CO≤5 L / min的患者死亡风险更高 (危险比0.44; 95%CI 0.25-0.77; p = 0.004)。

 

        在患有高风险静脉曲以及失代偿性肝硬化患者中,β受体阻滞剂的对全身血流动力学反应更大,门静脉压降较小。β受体阻滞剂对CO的短期作用可能会对代偿性肝硬化患者的生存产生不利影响。

 

 

原始出处:

Edilmar Alvarado-Tapias. Et al. Short-term hemodynamic effects of β-blockers influence survival of patients with decompensated cirrhosis. Journal of Hepatology.2020.

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    2021-08-01 zhyy88
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    2021-04-30 MedSciZeng

    #J Hepatology#点击进入话题查看更多相关文章 或评论时插入话题加入讨论

    0

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  7. 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    2020-10-08 gwc384
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    2020-10-07 yangchou

    肝硬化治疗新理念

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