非选择性β受体阻滞剂治疗肝硬化门静脉高压的最新进展  

Progress in Treatment of Cirrhotic Portal Fibrosis with Non-Selective Beta-Blockers

作　　者：魏长利 罗斌[1] 陈蕾[1] 陈建勇[1] WEI Chang-li;LUO Bin;CHEN Lei;CHEN Jian-yong(Department of Gastroenterology,Jiangxi Provincial People’s Hospital,Nanchang 330006,China)

机构地区：[1]江西省人民医院消化内科,南昌330006

出　　处：《实用临床医学（江西）》2022年第6期117-121,共5页Practical Clinical Medicine

基　　金：江西省自然科学基金(20202BABL206013)。

摘　　要：非选择性β受体阻滞剂(non-selective beta-blockers,NSBBs)是治疗肝硬化门静脉高压(cirrhotic portal fibrosis,CPF)的重要药物之一,其效果被充分肯定,可有效降低门静脉压力、预防曲张静脉破裂出血,但NSBBs并非对所有门静脉高压患者有效。文章认为根据CPF危险程度分级可判断是否使用NSBBs:一级患者其病理改变具有可逆性,以病因治疗为主,不推荐使用;二级患者无明显静脉曲张也不推荐,使用反而会出现药物的不良反应;三级患者中Child-pugh A/B级者建议使用且效果肯定,Child-pugh C级是否使用尚存争议,但多不建议进行NSBBs联合内镜下曲张静脉套扎术(endoscopic variceal ligation,EVL)治疗;四级患者禁用;五、六级患者的治疗主要为降低出血风险预防再次出血,Child-pugh A/B级者推荐使用,Child-pugh C级多不建议使用,特别是顽固性腹水、严重心肾功能不全等多禁用。使用NSBBs的窗口期目前还未确定,需更多的临床研究加以佐证。Non-selective beta-blockers(NSBBs)have been recognized as important drugs for the treatment of liver cirrhosis portal hypertension(CPF).They can effectively reduce portal pressure and prevent esophagogastric variceal bleeding.However,NSBBs are not effective for all portal hypertension patients.According to the risk grade of CPF,the use of NSBBs can be judged as follows:NSBBs are not recommended and etiological treatment should be performed in gradeⅠpatients due to the pathological changes are reversible;NSBBs are not recommended in gradeⅡpatients without obvious varicose veins due to adverse drug reactions;Among gradeⅢpatients,NSBBs are recommended due to positive effect in Child-pugh A/B patients.The use of NSBBs is still controversial in Child-pugh C patients,but the combination of NSBBs and endoscopic variceal ligation(EVL)is not recommended for most cases;NSBBs are forbidden in gradeⅣpatients;In gradeⅥ/Ⅶpatients,the treatment is mainly to reduce the risk of bleeding and prevent rebleeding.NSBBs are recommended in Child-pugh A/B patients,but not recommended in most Child-pugh C patients,especially patients with refractory ascites and serious cardiac and renal insufficiency.The window period for use of NSBBs still remains unclear,and it should be proven by more clinical studies.

关 键 词：肝硬化 门静脉高压 非选择性Β受体阻滞剂 危险程度 食管胃底静脉曲张 

分 类 号：R575.2[医药卫生—消化系统]