卡维地洛对肝硬化门静脉高压食管胃静脉曲张出血的防治作用研究进展

doi:10.3969/j.issn.1672-5069.2016.04.036

摘要/Abstract

摘要： 门静脉高压是食管胃静脉曲张出血的主要原因,有效降低门静脉压力梯度是预防食管胃静脉曲张出血的关键。卡维地洛是一类具有潜在的非心脏选择性的β受体和α受体阻滞剂,可通过降低门静脉压力进而减少食管胃静脉曲张的出血风险。本文就卡维地洛相比于传统的β受体阻滞剂如普萘洛尔或奈比洛尔、内镜下套扎、β受体阻滞剂联合硝酸酯类等治疗方案对食管胃静脉曲张出血的防治作用和不良反应进行分析,以期更好的指导临床治疗。

关键词: 肝硬化, 门脉高压症, 食管胃静脉曲张, 非选择性β, -受体阻滞剂, 卡维地洛

Abstract: Since portal hypertension is the primary cause of gastroesophageal variceal bleeding, an effective reduction in the hepatic venous pressure gradient（HVPG） contributes mainly to the cure of variceal bleeding. As a non-selective β1/β2 and α1 adrenoceptor antagonist,carvedilol decreases the risk of variceal bleeding by the means of relieving portal hypertension. In this paper,we review the prevention of carvedilol on gastroesophageal variceal haemorrhage with emphasis on its outstanding features over classical beta-blockers such as propranolol and nebivolol,or other therapies as band ligation,or combination of propranolol and nitrates with the hope of providing a better guidance to clinic practice.

Key words: Cirrhosis, Portal hypertension, Gastroesophageal variceal bleeding, Non-selective β1/β2 antagonists, Carvedilol

张冬琴, 吴吉圆综述, 龚作炯审校. 卡维地洛对肝硬化门静脉高压食管胃静脉曲张出血的防治作用研究进展[J]. 实用肝脏病杂志, 2016, 19(4): 509-509.

Zhang Dongqin, Wu Jiyuan, Gong Zuojiong. Carvedilol in the management of patients with portal hypertension[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2016, 19(4): 509-509.

参考文献

[1] 中华医学会消化病学分会,中华医学会肝病学分会,中华医学会内镜学分会等.肝硬化门静脉高压食管胃静脉曲张出血的防治共识.中华消化杂志,2008,28（8）:551-558.
[2] Simonetto DA,Shah VH,Kamath PS. Primary prophylaxis of variceal bleeding. Clin Liver Dis,2014,18（2）:335-345.
[3] LamuraV,Abraldes JG,Raffa S, et a1. Prognostic value of acute hemodynamic response to i.v. propranolol in patients with cirrhosis and portal hypertension. J Hepatol,2009,51（2）:279-287.
[4] Banares R,Moitinho E,Matilla A,et a1. Randomized comparison of long-term carvedilol and propranolol administration in the treatment of portal hypertension in cirrhosis. Hepatology,2002,36（6）:1367-1373.
[5] Tripathi D,Hayes PC. Beta-blockers in portal hypertension: new developments and controversies. Liver Int,2014,34:655-667.
[6] 徐晓琦,李民.丹参、心得安对门静脉高压症大鼠门静脉压力、肝纤维化指标及胃肠激素的影响. 浙江中医药大学学报,2010,34（3）:312-313.
[7] Hemstreet BA. Evaluation of carvedilol for the treatment of portal hypertension. Pharmacotherapy,2004,24（1）:94-104.
[8] Reiberger T,Ulbrich G,Ferlitsch A,et a1. Carvedilol for primary prophylaxis of variceal bleeding in cirrhotic patients with haemodynamic non-response to propranolol. Gut,2013,62（11）:1634-1641.
[9] Akbas H,Ozden M,Kanko M,et al. Protective antioxidant effects of carvedilol in a rat model of ischaemia reperfusion injury. J Int Med Res,2005,33（5）:528-536.
[10] Rolo AP,Oliveira PJ,Moreno AJ,et a1. Chenodeoxy cholate induction of mitochondrial permeability transition pore is associated with increased membrane fluidity and cytochrome c release:protective role of carvedilol. Mitochondrion,2003,2（4）:305-311.
[11] Dulin B,Abraham WT. Pharmacology of carvedilol. Am J Cardiol,2004,93（9A）:3B-6B.
[12] Hamdy N,El-Demerdash E.New therapeutic aspect for carvedilol:Antifibrotic effects of carvedilol in chronic carbon tetrachloride induced liver damage. Toxicol Appl Pharmacol,2012,261（3）:292-299.
[13] Banares R,Moitinho E,Piqueras B,et al. Carvedilol,a new non selectiveve beta-blocker with intrinsic anti-alpha1-adrenergic activity,has a greater portal hypotensive effect than propranolol in patients with cirrhosis. Hepatology,1999,30（1）:79-83.
[14] De BK,Das D,Sen S,et al. Acute and 7-day portal pressure response to carvedilol and propranolol in cirrhotics. J Gastroenterol Hepatol,2002,17:183-189.
[15] Dhiraj T,Peter CH. The role of carvedilol in the management of portal hypertension. Eur J Gastroenterol Hepatol,2010,22（8）:905-911.
[16] Sinagra E,Perricone G,D’Amico M,et al. Systematic review with meta-analysis:the haemodynamic effects of carvedilol compared with propranolol for portal hypertension in cirrhosis. Aliment Pharmacol Ther,2014,39（6）:557-568.
[17] Hobolth L,Moller S,Gronbaek H,et al. Carvedilol or propranolol in portal hypertension A randomized comparison. Scand J Gastroenterol,2012,47（4）:467-474.
[18] Silkauskaite V,Pranculis A,Kupcinskas J,et al. Acute and 14-days hepatic venous pressure gradient response to carvedilol and nebivolol in patients with liver cirrhosis. Medicina （Kaunas）,2013,49（11）:467-473.
[19] Tfipathi D,Ferguson JW,Kochar N,et a1. Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed. Hepatology,2009,50（3）:825-833.
[20] Bosch J. Carvedilol for portal hypertension in patients with cirrhosis. Hepatology,2010,51（6）:2214-2218.
[21] Hasnain AS,Zahid A,Javeria R,et a1. Carvedilol vs. esophageal variceal band ligation in the primary prophylaxis of variceal hemorrhage:A multicentre randomized controlled trial. J Hepatol,2014,60（4）:757-764.
[22] Serste T,Francoz C,Durand F,et al. Beta-blockers cause paracentesis-induced circulatory dysfunction in patients with cirrhosis and refractory ascites:a cross-over study. J Hepatol,2011,55（4）:794-799.
[23] Bosch J. Carvedilol:theβ-blocker of choice for portal hypertension. Gut,2013,62（11）:1529-1530.
[24] Adrian JS,Sheila D,Peter CH,et a1. Multicentre randomised controlled study comparing carvedilol with variceal band ligation in the prevention of variceal rebleeding. J Hepatol,2014, 61（5）:1014-1019.
[25] Merkel C,Marin R,Sacerdoti D,et al. Long-term results of a clinical trial of nadolol with or without isosorbide mononit rate for primary prophylaxis of variceal bleeding in cirrhosis. Hepatology,2001,31（2）:324-329.
[26] Lin HC,Yang YY,Hou MC,et al. Acute administration of carvedilol is more effective than propranolol plus isosorbide-5-mononitrate in the reduction of portal pressure in patients with viral cirrhosis. Am J Gastroenterol,2004,99（10）:1953-1958.
[27] Lo GH,Chen W C,Wang HM,et a1.Randomized,controlled trial of carvedilol versus nadolol plus isosorbide mononitrate for the prevention of variceal rebleeding. J Gastroenterol Hepatol, 2012,27（11）:1681-1687.