Am J Gastroenterol:非选择性β受体阻滞剂可有效预防肝硬化患者食管静脉曲张破裂出血

2016-10-11 Mechront 译 MedSci原创

先前的研究已经表明,非选择性β受体阻滞剂(NSBB)可有效预防肝硬化患者食管静脉曲张破裂出血。但是目前关于常规临床护理中NSBB的整体效果还是未知的。 我们进行了一项回顾性队列研究,纳入了既往没有出血史的肝硬化患者,在2008年到2013年开始使用NSBB (propranolol, nadolol)。主要终点是12个月内的食管静脉曲张破裂出血事件。使用Cox比例风险识别与食管静脉曲张破裂出

先前的研究已经表明,非选择性β受体阻滞剂(NSBB)可有效预防肝硬化患者食管静脉曲张破裂出血。但是目前关于常规临床护理中NSBB的整体效果还是未知的。

我们进行了一项回顾性队列研究,纳入了既往没有出血史的肝硬化患者,在2008年到2013年开始使用NSBB (propranolol, nadolol)。主要终点是12个月内的食管静脉曲张破裂出血事件。使用Cox比例风险识别与食管静脉曲张破裂出血相关的人口统计学、临床、NSBB相关因素。

5775例患者中,678(11.7%)例患者出现了静脉曲张破裂出血。平均每日NSBB剂量<40 mg的占58.8%,18.1%的患者有向上或向下调节NSBB剂量,9.8%的患者有血流动力学反应。更高的食管静脉曲张破裂出血风险与以下因素有关:年轻患者、有腹水、更严重的合并症、更高的MELD(终末期肝病模型)得分。以下情况可以降低食管静脉曲张破裂出血风险:每日剂量更高(HR 0.64; 95% CI 0.51–0.81)、向上或向下调节剂量(HR 0.69; 95% CI: 0.52–0.90、0.64; 95% CI 0.45–0.90)、达到血流动力学反应(HR 0.75; 95% CI=0.57–1.0)。

结果表明,在使用NSBB进行预防治疗后,大约12%的患者会出现食管静脉曲张破裂出血;更高的NSBB剂量和滴定剂量的NSBB可有效预防事件的发生;我们的数据显示,对于使用NSBB的肝硬化患者,需要仔细监测。

原始出处:

Richa Shukla.et al.Risk and Predictors of Variceal Bleeding in Cirrhosis Patients Receiving Primary Prophylaxis With Non-Selective Beta-Blockers.Am J Gastroenterol advance online publication 27 September 2016

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    2016-12-19 fusion
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objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K46ZAxBHmHsph32KkfsWGwmickB6RsCUD8KruE4vo5CpvXfdu16GBpp4ibh6WJu1o9iatP1LWKDmvmic/0, createdBy=be6f1940165, createdName=1e0ece0dm09(暂无匿称), createdTime=Fri Oct 14 21:03:31 CST 2016, time=2016-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148147, encodeId=646814814e14, content=不错,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTI9X140JXPuaKWWY7pcpOQCp6jSFssJq9bMmib99rYzz8SfbLfY5pUjllibm9p9j97e04VpDTJCq8uw/132, createdBy=5a171686354, createdName=1de48adem68(暂无匿称), createdTime=Fri Oct 14 13:14:59 CST 2016, time=2016-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148079, encodeId=05291480e94e, content=不错,继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Oct 14 10:18:22 CST 2016, time=2016-10-14, status=1, ipAttribution=)]
    2017-04-17 zhyy88
  5. 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  6. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148079, encodeId=05291480e94e, content=不错,继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Oct 14 10:18:22 CST 2016, time=2016-10-14, status=1, ipAttribution=)]
  7. 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channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7853, encryptionId=94ffe853a7, topicName=Gastroenterol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0bed488, createdName=jktdtl, createdTime=Sun Jul 30 10:29:00 CST 2017, time=2017-07-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2071681, encodeId=8ee120e1681ea, content=<a href='/topic/show?id=9d4ee84647' target=_blank style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7846, encryptionId=9d4ee84647, topicName=GAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2dd327, createdName=许安, createdTime=Sat Apr 01 22:29:00 CST 2017, time=2017-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148270, encodeId=1fb31482e0bc, content=谢谢谢谢指点, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K46ZAxBHmHsph32KkfsWGwmickB6RsCUD8KruE4vo5CpvXfdu16GBpp4ibh6WJu1o9iatP1LWKDmvmic/0, createdBy=be6f1940165, createdName=1e0ece0dm09(暂无匿称), createdTime=Fri Oct 14 21:03:31 CST 2016, time=2016-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148147, encodeId=646814814e14, content=不错,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTI9X140JXPuaKWWY7pcpOQCp6jSFssJq9bMmib99rYzz8SfbLfY5pUjllibm9p9j97e04VpDTJCq8uw/132, createdBy=5a171686354, createdName=1de48adem68(暂无匿称), createdTime=Fri Oct 14 13:14:59 CST 2016, time=2016-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148079, encodeId=05291480e94e, content=不错,继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Oct 14 10:18:22 CST 2016, time=2016-10-14, status=1, ipAttribution=)]
    2017-04-01 许安
  8. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148079, encodeId=05291480e94e, content=不错,继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Oct 14 10:18:22 CST 2016, time=2016-10-14, status=1, ipAttribution=)]
    2016-10-14 1e0ece0dm09(暂无匿称)

    谢谢谢谢指点

    0

  9. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148079, encodeId=05291480e94e, content=不错,继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Oct 14 10:18:22 CST 2016, time=2016-10-14, status=1, ipAttribution=)]
    2016-10-14 1de48adem68(暂无匿称)

    不错,学习了

    0

  10. 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objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K46ZAxBHmHsph32KkfsWGwmickB6RsCUD8KruE4vo5CpvXfdu16GBpp4ibh6WJu1o9iatP1LWKDmvmic/0, createdBy=be6f1940165, createdName=1e0ece0dm09(暂无匿称), createdTime=Fri Oct 14 21:03:31 CST 2016, time=2016-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148147, encodeId=646814814e14, content=不错,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTI9X140JXPuaKWWY7pcpOQCp6jSFssJq9bMmib99rYzz8SfbLfY5pUjllibm9p9j97e04VpDTJCq8uw/132, createdBy=5a171686354, createdName=1de48adem68(暂无匿称), createdTime=Fri Oct 14 13:14:59 CST 2016, time=2016-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=148079, encodeId=05291480e94e, content=不错,继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Oct 14 10:18:22 CST 2016, time=2016-10-14, status=1, ipAttribution=)]
    2016-10-14 1e10c84am36(暂无匿称)

    不错,继续学习

    0