非选择性β受体阻滞剂在肝硬化治疗中的应用  

Advances in the application of nonselectiveβ-receptor blockers in treatment of liver cirrhosis

作　　者：刘一锋 王小泽 杨丽[1,2] LIU Yifeng;WANG Xiaoze;YANG Li(Department of Gastroenterology,West China Hospital,Sichuan University,Chengdu 610041,China;Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院消化内科,成都610041 [2]四川大学华西医院四川大学-牛津大学华西消化道肿瘤联合研究中心,成都610041

出　　处：《临床肝胆病杂志》2023年第5期1178-1183,共6页Journal of Clinical Hepatology

基　　金：四川省科技厅国际科技创新合作项目(2021YFH0099)。

摘　　要：非选择性β受体阻滞剂(NSBB)是肝硬化患者门静脉高压并发症防治的一线药物,广泛用于食管胃静脉曲张出血的一级预防和二级预防。近年来,在临床显著性门静脉高压(CSPH)患者中,NSBB已被证实还可以预防静脉曲张出血以外的其他肝硬化失代偿事件,如腹水和肝性脑病等。然而,在非CSPH的代偿期患者中,目前的研究证据不支持使用NSBB。尽管目前有可靠数据支持NSBB用于终末期肝硬化,但对于部分顽固性腹水和自发性腹膜炎患者仍存在用药安全问题,给药剂量和时机仍有待研究。本文综述了目前关于肝硬化患者使用NSBB(尤其是卡维地洛)的相关临床研究进展,并总结NSBB在肝硬化全程管理中合理应用的治疗窗口,为临床决策提供依据。Nonselectiveβ-receptor blockers(NSBBs)are first-line drugs for the prevention and treatment of complications in cirrhotic patients with portal hypertension and are widely used in the primary and secondary prevention of esophagogastric variceal bleeding.In recent years,studies have shown that in patients with clinically significant portal hypertension(CSPH),NSBBs can used to prevent liver decompensation events besides variceal bleeding,such as ascites and hepatic encephalopathy.However,in patients without CSPH,current research evidence does not support the use of NSBBs.Although reliable data currently support the use of NSBBs in end-stage liver cirrhosis,there are still drug safety issues in patients with refractory ascites and spontaneous bacterial peritonitis,and further studies are needed to explore the dose and timing of administration.This article reviews the clinical research advances in the use of NSBBs(especially carvedilol)in patients with liver cirrhosis and summarizes the therapeutic window used reasonably in the whole-course management of liver cirrhosis,so as to provide a basis for clinical decision-making.

关 键 词：肝硬化 非选择性Β受体阻滞剂 高血压 门静脉 治疗学 

分 类 号：R575.2[医药卫生—消化系统]