血管紧张素II受体阻滞剂治疗肝硬化门脉高压的研究

Study of angiotensin II receptor blocker in treating cirrhosis patients with portal hypertension

目的通过与非选择性β-受体阻滞剂普奈洛尔的比较探讨血管紧张素II受体阻滞剂洛沙坦对肝硬化门脉高压病人门静脉压力的影响。方法选择肝硬化伴门脉高压患者32例,随机分为洛沙坦(25mg/d)治疗组和普奈洛尔(30￣80mg/d)治疗组,在治疗前和治疗2、3周时分别应用彩色多普勒超声仪测量每位患者的门静脉内径(DPV)及门静脉血流速度(VPV),对比这两种药物对门静脉压力影响。结果普奈洛尔组治疗后DPV下降、VPV增快,治疗前后的数值分别为,(14.44±1.41)mm,(7.75±1.20)cm/s及(12.13±1.49)mm,(11.25±1.82)cm/s,P<0.05。洛沙坦组治疗后DPV亦明显下降,VPV增快,治疗前后数值分别为,(14.69±1.31mm,7.50±1.22)cm/s及(12.00±1.37)mm,(11.00±1.54)cm/s,P<0.05。但两组药物之间无统计学差异。在笔者的研究过程中,这两组患者均未发生有意义的不良反应。结论血管紧张素II受体阻滞剂洛沙坦和非选择性β受体阻滞剂普奈洛尔一样,是一种安全、有效的降低肝硬化门脉高压患者门静脉压力的药物。

[Objective] This study evaluates the effect of losartan, an angiotensin Ⅱ receptor blocker, on portal pressure in cirrhosis patients with portal hypertension compared with proparnolol, a non-alternative β receptor blocker. [Methods] A total of 32 cirrhosis individuals with portal hypertension were randomized into two groups and were treated with losartan （25 mg/d） and propranolol （30-80 mg/d） respectively. The effects on portal pressure of the two medicines were compared through respectively measuring DPV and VPV of each patients with Doppler before treatment and after 2-3 weeks. [Results] With propranolol, DPV of patients declined and VPV of patients quickened. The values were respectively （14.44±＋1.41） mm, （7.75±1.20） cm/s and （12.13±1.49） mm, （1.25±1.82） cm/s, （P 〈 0.05） before and after treatment. With losartan, DPV of patients remarkably declined and VPV of patients quickened. The values were respectively （14.69±1.31） mm, （7.50±1.22） cm/s and （12.00±1.37） mm, （11.00±1.54） cm/s, （P 〈0.05） before and after treatment. There was no statistical difference between the two medicines. During the study, no significant side effects were observed. [Conclusion] Losartan, an angiotensin Ⅱ receptor blocker, is as safe and effective as propranlol in reducing portal pressure in cirrhosis patients with portal hypertension.