普萘洛尔与卡维地洛预防肝硬化患者并发食管胃静脉曲张破裂出血临床疗效比较*

doi:10.3969/j.issn.1672-5069.2023.02.026

实用肝脏病杂志 ›› 2023, Vol. 26 ›› Issue (2): 254-257.doi: 10.3969/j.issn.1672-5069.2023.02.026

普萘洛尔与卡维地洛预防肝硬化患者并发食管胃静脉曲张破裂出血临床疗效比较^*

程洋, 张峰, 王曦旋, 尹晓春, 肖江强, 张明, 王雷, 邹晓平, 诸葛宇征

210008 南京市江苏大学鼓楼临床医学院消化科( 程洋,张峰,诸葛宇征);南京大学医学院附属鼓楼医院消化科( 尹晓春,肖江强,张明,王雷,邹晓平);东南大学医学院南京鼓楼医院(王曦旋)

收稿日期:2022-08-01 出版日期:2023-03-10 发布日期:2023-03-21
通讯作者: 诸葛宇征,E-mail:yuzheng9111963@aliyun.com
作者简介:程洋,男,28岁,硕士研究生。E-mail:chengyang5085@outlook.com
基金资助:
^*南京市医学科技发展重点研究项目(编号:ZKX14017)

Comparison of clinical efficacy of carvedilol and propranolol in preventing esophagogastric varices bleeding in patients with liver cirrhosis

Cheng Yang, Zhang Feng, Wang Xixuan, et al.

Department of Gastroenterology, Drum Tower Hospital, Jiangsu University Clinical College, Nanjing 210008, Jiangsu Province, China

Received:2022-08-01 Online:2023-03-10 Published:2023-03-21

摘要/Abstract

摘要： 目的比较普萘洛尔与卡维地洛预防肝硬化患者并发食管胃静脉曲张破裂出血的临床疗效和安全性。方法 2013年4月～2020年9月南京鼓楼医院消化科收治的连续肝硬化并发食管胃静脉曲张患者377例,符合纳入和排除标准患者312例,分别接受普萘洛尔(n=122)或卡维地洛(n=190)预防治疗。常规行肝静脉楔压(WHVP)和肝静脉游离压(FHVP)测定,计算肝静脉压力梯度(HVPG)。随访。结果在随访期间,普萘洛尔处理组食管胃静脉曲张破裂出血(EVB)发生率为34.4%,显著高于卡维地洛处理组的13.2%(P＜0.05);病死率分别为5.7%和1.6%(P＞0.05);治疗后,66例普萘洛尔组WHVP、FHVP和HVPG分别为(22.7±5.1)mmHg、9.0(6.0~11.0)mmHg和(13.7±3.5)mmHg,与32例卡维地洛治疗组[(22.5±4.5)mmHg、(8.0(6.0~10.0))mmHg和(14.5±3.8)mmHg]比,差异无统计学意义(P>0.05)。结论尽管在降低HVPG方面无显著性差异,应用卡维地洛预防肝硬化患者EVB的效果比普萘洛尔更优,值得进一步研究。

关键词: 肝硬化, 食管胃静脉曲张, 卡维地洛, 普萘洛尔, 肝静脉压力梯度, 治疗

Abstract: Objective The purpose of this study was to compare the clinical efficacy of carvedilol and propranolol in preventing esophagogastric varices bleeding (EVB) in patients with liver cirrhosis. Methods 312 cirrhotics eligible for inclusion were encountered in our hospital between April 2013 and September 2020, and out of them, carvedilol were given in 190 cases and propranolol were given in 122 cases. All patients were followed-up until December 2020. The wedged hepatic venous pressure (WHVP) and free hepatic venous pressure (FHVP) were routinely determined and the hepatic venous pressure gradient (HVPG) was calculated. Results During the follow-up period, the incidence of EVB in propranolol-treated patients was 34.4%, significantly higher than 13.2%(P＜0.05) in carvedilol-treated patients; the fatality rates in the two groups were 5.7% and 1.6%(P＞0.05); after treatment, the WHVP, FHVP and HVPG in 66 propranolol-treated patients were (22.7±5.1)mmHg, 9.0(6.0-11.0)mmHg and (13.7±3.5)mmHg, not significantly different compared to[(22.5±4.5)mmHg, 8.0(6.0~10.0) mmHg and (14.5±3.8)mmHg] in 32 carvedilol-treated patients (P>0.05). Conclusion The efficacy of carvedilol in preventing EVB in patients with liver cirrhosis and esophagogastric varices is superior to propranolol, although there is no significant difference as respect to the reduction of HVPG by the two medicines.

Key words: Liver cirrhosis, Esophagogastric varices, Carvedilol, Propranolol, Hepatic venous pressure gradient, Therapy

程洋, 张峰, 王曦旋, 尹晓春, 肖江强, 张明, 王雷, 邹晓平, 诸葛宇征. 普萘洛尔与卡维地洛预防肝硬化患者并发食管胃静脉曲张破裂出血临床疗效比较^*[J]. 实用肝脏病杂志, 2023, 26(2): 254-257.

Cheng Yang, Zhang Feng, Wang Xixuan, et al.. Comparison of clinical efficacy of carvedilol and propranolol in preventing esophagogastric varices bleeding in patients with liver cirrhosis[J]. Journal of Practical Hepatology, 2023, 26(2): 254-257.

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普萘洛尔与卡维地洛预防肝硬化患者并发食管胃静脉曲张破裂出血临床疗效比较^*

Comparison of clinical efficacy of carvedilol and propranolol in preventing esophagogastric varices bleeding in patients with liver cirrhosis

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