普萘洛尔降低肝硬化患者肝静脉压力梯度的影响因素  

Effect factors analysis of propranolol decreasing hepatic venous pressure gradient in patients with liver cirrhosis

作　　者：段旭红[1] 张峰[1] 张明[1] 徐慧[1] 贺奇彬[1] 王轶[1] 陈培忠[2] 诸葛宇征[1] 

机构地区：[1]南京大学医学院附属鼓楼医院消化科,210008 [2]厦门大学附属中山医院消化科

出　　处：《中华消化杂志》2016年第3期150-154,共5页Chinese Journal of Digestion

基　　金：南京市医学科技发展重点项目（ZKX14017）

摘　　要：目的探讨使用普萘洛尔预防食管胃静脉曲张破裂出血（EGVB）对肝硬化伴食管胃静脉曲张患者肝静脉压力梯度（HVPG）应答的影响因素。方法纳入2012年3月至2015年9月进行HVPG测定后服用普萘洛尔的45例肝硬化伴食管胃静脉曲张患者，在第2次HVPG测定后分成HVPG应答组和无应答组。比较两组患者的人口学、临床资料、血流动力学指标和血清中普萘洛尔浓度。统计学分析行t检验、卡方检验或秩和检验。结果45例患者中，28例（62．2％）产生HVPG应答，17例未产生HVPG应答。两组年龄、性别、肝硬化病因、肝功能和预防指征方面差异均无统计学意义（P均〉0．05）。HVPG应答组和无应答组的平均动脉压降幅分别为3．0mmHg（-2．8mmHg，9．8mmHg）（1mmHg-0．133kPa）和1．0mmHg（-5．5mmHg，9．5mmHg），差异无统计学意义（P〉0．05）。HVPG应答组的基础心率由用药前的（68．6±8．6）次／min降至用药后的（59．6±7．1）次／min，差异有统计学意义（t=4．292，P〈0．01）；无应答组的基础心率由（68．6±7．4）次／min降至（60．4±7．5）次／min，差异有统计学意义（t=3．217，P=0．003）；应答组与无应答组基础心率降低幅度分别为（12．6±9．4）％和（11．5±10．3）％，差异无统计学意义（t=0．358，P=0．722）。HVPG应答组与无应答组使用普萘洛尔后144h的血清峰值浓度分别为89．5ug／I．（58．5μg／L，158．5μg／L）和48．0μg／L（33．5μg／L，157．5ug／L），差异无统计学意义（t=-1．371，P=0．174）。结论肝硬化伴食管胃静脉曲张患者年龄、性别、肝硬化病因、肝功能、预防指征、血压变化、基础心率降幅和血清中普萘洛尔浓度均与HVPG应答无关，不能准确预测血流动力学应答，仍需要进一步探讨准确的能替代HVPG的血流动力学应答的预测指标。Objective To explore the effect factors of hepatic venous pressure gradient （HVPG） responsed to propranolol used to prevent esophageal and gastric varices bleeding （EGVB） in patients with liver cirrhosis and esophageal and gastric varices. Methods From March 2012 to September 2015, 45 patients with liver cirrhosis and esophageal and gastric varices taking propranolol after HVPG measurement were enrolled. After the second HVPG measurement, the patients were divided into HVPG response group and nonresponse group. The demographic features, clinical data, hemodynamic parameters, age, and serum propranolol concentration were compared between the two groups. The t test, chi-square test and rank sum test were performed for statistical analysis. Results Among 45 patients, 28 patients （62.2%） had response and 17 patients did not have HVPG response. There was no statistically significant difference in the age, gender, etiology for liver cirrhosis, liver function and prophylaxis indication between the two groups （all P〉0.05）. The decrease of mean arterial pressure of HVPG response group and nonresponse group was 3.0 mmHg （=2.8 mmHg, 9.8 mmHg） （1 mmHg= 0. 133 kPa） and 1.0 mmHg （-5. 5 mmHg, 9. 5 mmHg）, and the difference was not statistically significant （P〉0.05）. The basic heart rate of HVPG response group decreased from （68.6±8.6） beat per minute （bpm） before medication treatment to （59.6±7.1） bpm after medication treatment, and the difference was statistically significant （t 4. 292,P〈0.01）. The basic heart rate of nonresponse group decreased from （68.6±7.4） bpm to （60.4±7.5） bpm, and the difference was statistically significant （t = 3.217, P = 0. 003）. The amplitudes of decrease of heart rates of response group and nonresponse group were （12.6±9.4）% and （ 11.5 ~ 10.3）%, respectively, and the difference was not statistically significant （t = 0.358, P = 0.722）. After taking propranolol for 144 hours, the serum drug peak concentrations of respo

关 键 词：肝硬化 肝静脉压力梯度 普萘洛尔 血流动力学应答 预测 

分 类 号：R575.2[医药卫生—消化系统]