阿罗洛尔对肝硬化患者肝静脉压力梯度及血流动力学的影响

Effect of arolol on hepatic venous pressure gradient and hemodynamics in patients with liver cirrhosis

目的评价阿罗洛尔对肝静脉压力梯度(hepatic venous pressure gradient,HVPG)及血流动力学的影响。方法选取2019年6月1日至12月31日首都医科大学附属北京佑安医院收治的肝硬化合并中、重度食管静脉曲张患者16例,行HVPG测定后给予阿罗洛尔口服,起始剂量为10 mg/次,1次/d,逐步调整药物剂量,以心率降低基础水平的20%~25%且心率不低于55次/min,血压不低于90/60 mmHg(1 mmHg=0.133 kPa)时的药物剂量作为维持剂量,最大剂量不超过30 mg/d。待达到上述血流动力学稳态且总服药时间满3个月后,行第2次HVPG测定。结果16例患者服用阿罗洛尔前HVPG为(16.25±3.45)mmHg,3个月后降至(14.63±3.58)mmHg,差异有统计学意义(P=0.000);有7例(43.8%)用药后HVPG降至12 mmHg以下和(或)至少较基础降低20%;服药后的静息心率[(67.06±6.91)次/min比(76.75±9.26)次/min]、DBP[74.50(70.00,78.75)mmHg比81.00(80.00,84.25)mmHg]、门静脉主干直径[(12.63±1.69)mm比(13.50±1.60)mm]、脾静脉直径[(9.38±1.60)mm比(11.50±2.67)mm]均低于服药前,差异有统计学意义(P<0.05)。随访发现1例(6.3%)1年内发生食管静脉曲张破裂出血。用药前后血常规、肝功能、凝血、食管静脉曲张程度的差异无统计学意义(P>0.05)。结论阿罗洛尔可显著降低伴有中、重度食管静脉曲张的肝硬化患者的HVPG,降低门静脉及脾静脉直径,具有潜在的预防静脉曲张破裂出血的应用前景。

Objective To evaluate the effect of arolol on hepatic venous pressure gradient(HVPG)and hemodynamics in the patients with liver cirrhosis.Methods Sixteen patients with cirrhosis complicated with moderate or severe esophageal varices who were admitted to Beijing Youan Hospital,Capital Medical University from June 1 st to December 31 st,2019 were selected.All the patients were treated with arolol at the initial dose of 10 mg/d,and the dose was gradually adjusted until the hemodynamics was stable.HVPG was measured before treatment.The initial dose of arolol was 10 mg once a day,and the drug dose was gradually adjusted until the heart rate decreased by 20%-25%of the original level,the heart rate was not less than 55 bpm,and the blood pressure was not less than 90/60 mmHg(1 mmHg=0.133 kPa).As the maintenance,and the maximum dose didn’t exceed 30 mg/d.After reaching stable hemodynamic state,HVPG was measured three months after treatment.The data of blood routine,blood biochemistry,blood pressure,diameter of main portal vein and splenic vein,degree of varicose vein under gastroscope were collected before treatment and three months after treatment.Results HVPG of all the patients was(16.25±3.45)mmHg,which significantly decreased to(14.63±3.58)mmHg after three months(P=0.000).In seven patients(43.8%),HVPG decreased below 12 mmHg and/or at least 20%lower than the baseline.Compared with pre-treatment,there were significant decrease in resting heart rate[(67.06±6.91)bpm vs.(76.75±9.26)bpm],diastolic blood pressure[74.50(70.00,78.75)mmHg vs.81.00(80.00,84.25)mmHg],main portal vein diameter[(12.63±1.69)mm vs.(13.50±1.60)mm]and splenic vein diameter[(9.38±1.60)mm vs.(11.50±2.67)mm]after treatment(P<0.05).One case(6.3%)had esophageal variceal bleeding within one year.There were no significant changes in blood routine,liver function,coagulation and degree of esophageal varices compared with pre-treatment and post-treatment.Conclusions Arolol can significantly reduce the HVPG of cirrhotic patients with moderate and severe esophageal varices,and reduce the diameter of portal vein and splenic vein.It has a potential application prospect in the prevention of variceal bleeding.