非选择性β受体阻滞剂在代偿性肝硬化患者中的新应用

摘要/Abstract

摘要： 肝硬化是所有慢性肝病的终末期阶段,延缓代偿性肝硬化向失代偿发展是肝硬化患者治疗的首要目标。失代偿性肝硬化的最主要表现是门静脉高压相关的并发症,非选择性β受体阻滞剂是治疗门静脉高压症的主要药物。然而,目前临床对其在代偿性肝硬化中的作用仍存在争议。本文对非选择性β受体阻滞剂在肝硬化门静脉高压中的临床研究进行评价,以帮助临床医生适时采取药物干预,选择合适的对象,改善肝硬化患者的生活质量和预后。

夏睿琦, 曾晓清, 陈世耀. 非选择性β受体阻滞剂在代偿性肝硬化患者中的新应用[J]. 肝脏, 2022, 27(2): 141-144.

参考文献

[1] Garcia-Tsao G, Abraldes JG. Nonselective beta-blockers in compensated cirrhosis: Preventing variceal hemorrhage or preventing decompensation? Gastroenterology, 2021,161:770-773.
[2] Abraldes JG, Trebicka J, Chalasani N, et al. Prioritization of Therapeutic Targets and Trial Design in Cirrhotic Portal Hypertension. Hepatology,2019,69:1287-1299.
[3] de Franchis R, Baveno VIF. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol,2015,63:743-752.
[4] Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology,2017,65:310-335.
[5] Magaz M, Baiges A, Hernandez-Gea V. Precision medicine in variceal bleeding: Are we there yet? J Hepatol,2020,72:774-784.
[6] Jachs M, Reiberger T. Prevention of Variceal Bleeding and Rebleeding by Nonselective Beta-Blockers: A Tailored Approach. Clin Liver Dis,2021,25:311-326.
[7] Li T, Ke W, Sun P, et al. Carvedilol for portal hypertension in cirrhosis: systematic review with meta-analysis. BMJ Open,2016,6:e010902.
[8] Qi XS, Bao YX, Bai M, et al. Nonselective beta-blockers in cirrhotic patients with no or small varices: A meta-analysis. World J Gastroenterol,2015,21:3100-3108.
[9] Ripoll C, Groszmann R, Garcia-Tsao G, et al. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology, 2007,133:481-488.
[10] Sasso R, Rockey DC. Non-selective beta-blocker use in cirrhotic patients is associated with a reduced likelihood of hospitalisation for infection. Aliment Pharmacol Ther, 2021,53:418-425.
[11] Turnes J, Garcia-Pagan JC, Abraldes JG, et al. Pharmacological reduction of portal pressure and long-term risk of first variceal bleeding in patients with cirrhosis. Am J Gastroenterol,2006,101:506-512.
[12] Kang SH, Lee M, Kim MY, et al. The longitudinal outcomes of applying non-selective beta-blockers in portal hypertension: real-world multicenter study. Hepatol Int, 2021,15:424-436.
[13] Jachs M, Hartl L, Schaufler D, et al. Amelioration of systemic inflammation in advanced chronic liver disease upon beta-blocker therapy translates into improved clinical outcomes. Gut, 2020,70(9):1758-1767.
[14] 中华医学会外科学分会脾及门静脉高压外科学组?. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版). 中华消化外科杂志,2019,18: 1087-1093.
[15] European Association for the Study of the Liver. European Association for the Study of the EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol,2018,69:406-460.
[16] Groszmann RJ, Garcia-Tsao G, Bosch J, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med,2005,353:2254-2261.
[17] Villanueva C, Albillos A, Genesca J, et al. beta blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, double-blind, placebo-controlled, multicentre trial. Lancet,2019,393:1597-1608.
[18] Lu Q, Leong S, Lee KA, et al. Hepatic venous-portal gradient (HVPG) measurement: pearls and pitfalls. Br J Radiol,2021,94:20210061.
[19] Schwarzer R, Kivaranovic D, Paternostro R, et al. Carvedilol for reducing portal pressure in primary prophylaxis of variceal bleeding: a dose-response study. Aliment Pharmacol Ther,2018,47:1162-1169.
[20] Dajti E, Alemanni LV, Marasco G, et al. Approaches to the Diagnosis of Portal Hypertension: Non-Invasive or Invasive Tests? Hepat Med,2021,13:25-36.
[21] Abraldes JG, Bureau C, Stefanescu H, et al. Noninvasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis: The "Anticipate" study. Hepatology,2016,64:2173-2184.
[22] Danielsen KV, Hove JD, Nabilou P, et al. Using MR elastography to assess portal hypertension and response to beta-blockers in patients with cirrhosis. Liver Int, 2021,41:2149-2158.
[23] Bosch J, Gracia-Sancho J, Abraldes JG. Cirrhosis as new indication for statins. Gut, 2020,69:953-962.
[24] Kim RG, Loomba R, Prokop LJ, et al. Statin Use and Risk of Cirrhosis and Related Complications in Patients With Chronic Liver Diseases: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol,2017,15:1521-1530 e8.