卡维地洛与普萘洛尔预防肝硬化并发食管静脉曲张首次破裂出血疗效比较

doi:10.3969/j.issn.1672-5069.2018.05.005

摘要/Abstract

摘要： 目的比较应用卡维地洛与普萘洛尔预防肝硬化并发食管静脉曲张首次破裂出血的疗效及安全性。方法 2012年6月~2015年6月在我院住院或门诊就诊的肝硬化并发中重度食管静脉曲张患者125例,采用随机数字表法将患者分成卡维地洛处理组（n=61例）和普萘洛尔处理组（n=64例）,分别接受卡维地洛或普萘洛尔预防服药,随访1年,比较两组首次消化道出血发生率、肝肾功能和肝静脉压力梯度（HVPG）变化和不良反应发生率情况。结果在61例卡维地洛处理组患者中,男性35例,女性26例,平均年龄为（48.4±13.8）岁。乙型肝炎肝硬化33例,有腹水者49例,Child-Pugh A级14例,B级38例,C级9例;在64例普萘洛尔处理组中,男性39例,女性25例,平均年龄为（50.1±15.7）岁。乙型肝炎肝硬化38例,有腹水者53例,Child-Pugh A级13例,B级41例,C级10例。两组一般临床资料比较差别无统计学意义（P>0.05）;在随访期间,卡维地洛组有18例（29.5%）患者出现食管胃底静脉曲张破裂出血,而普萘洛尔组有20例（31.3%）患者出现食管胃底静脉曲张破裂出血,两组差异无统计学意义（x²=0.45,P<0.05）;治疗前,卡维地洛组患者HVPG为（14.1±3.7） mmHg,治疗后下降至（10.3±2.1） mmHg,治疗前后差异有统计学意义（P<0.05）,而治疗前普萘洛尔组HVPG为（14.6±4.3） mmHg,治疗后下降至（12.0±2.3） mmHg,治疗前后差异有统计学意义（P<0.05）,但两组之间无显著性相差（P>0.05）;两组治疗前后血清谷丙转氨酶（ALT）、总胆红素（TBIL）和肌酐（Cr）水平变化差异无统计学意义（P>0.05）;在随访过程中,卡维地洛组共有10例患者出现头晕,3例患者出现晕厥,4例患者出现胸闷,1例患者出现气促,而普萘洛尔组则分别有8例、2例、6例和1例,两组不良反应发生率比较,差异无统计学意义（P>0.05）。结论卡维地洛预防肝硬化致食管胃底静脉曲张首次破裂出血的疗效与普萘洛尔相似,且安全,不良反应发生率低。

关键词: 肝硬化, 食管胃底静脉曲张破裂出血, 卡维地洛, 普萘洛尔, 预防

Abstract: Objective To assess the prophylactic effect of carvedilol and propranolol for first esophageal and gastric variceal bleeding in cirrhotic patients. Methods A total of 125 patients with liver cirrhosis and esophageal and gastric varices were randomly divided into carvedilol-intervened group（n=61） and propranolol-intervened group（n=64）,receiving carvedilol and propranolol respectively for prophylaxis of gastrointestinal bleeding. The first variceal bleeding,biochemical index,hepatic vein pressure gradient（HVPG） and side effect were compared between the two groups. Results The clinical data such as gender,age,Child-Pugh class and complications of ascites at presentation were not significantly different between the two group （P>0.05）;there were 18 patients （29.5%） having first esophageal and gastric variceal bleeding in carvedilol-intervened group, and there were 20 patients（31.3%） having first esophageal and gastric variceal bleeding in propranolol-treated group during the follow-up period,which showed no significant differences between the two groups（P>0.05）;the HVPG level in carvedilol-intervened group decreased significantly from （14.1±3.7） mmHg at presentation to （10.3±2.1） mmHg after treatment（P<0.05）,and the HVPG level in propranolol-treated group also decreased significantly from （14.6±4.3） mmHg to （12.0±2.3） mmHg （P<0.05） without significant difference between the two group（P>0.05）;the changes of serum ALT, bilirubin and creatinine levels between the two groups showed no significant differences（P>0.05）;there were 10 cases having dizziness,3 cases having syncope,4 cases having chest distress and 1 case having anhelation in carvedilol-intervened group,while there were 8,2,6 and 1 case,respectively,in the propranolol-treated group,suggesting no significant difference between the two groups as respect to the incidence of side effects （P>0.05）. Conclusions Both carvedilol and propranolol have good prophylactic effects for the first esophageal and gastric variceal bleeding in cirrhotic patients,which needs further investigation.

许红华. 卡维地洛与普萘洛尔预防肝硬化并发食管静脉曲张首次破裂出血疗效比较[J]. 实用肝脏病杂志, 2018, 21(5): 673-676.

Xu honghua.. Prophylactic efficacy of carvedilol and propranolol for first esophageal and gastric variceal bleeding in cirrhotic patients[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(5): 673-676.

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