Venon Wilma Debernardi, Baronio Monica, Leone Nicola, Rolfo Elio, Fadda Maurizio, Barletti Claudio, Todros Luca, Saracco Giorgio, Rizzetto Mario
Department of Gastroenterology, Ospedale Molinette, S. Giovanni Battista Hospital, C.so Bramante 88, 10126, Turin, Italy.
J Hepatol. 2003 Apr;38(4):455-60. doi: 10.1016/s0168-8278(02)00443-9.
BACKGROUND/AIMS: The role of angiotensin II (AT-II) type I receptor antagonists in the treatment of portal hypertension remains controversial. We tested the efficacy of Irbesartan (Irb) vs. Propranolol (Pro) in reducing portal pressure and evaluated its systemic haemodynamic effects.
Thirty-four patients were randomly assigned to receive either Irb 300 mg/day (19 patients) or Pro 40-120 mg/day (15 patients) for 2 months.
Irb was discontinued in five patients (26%). No major side effect occurred in the Pro group. On an average, the portal pressure gradient decreased significantly more in the Pro than in the Irb group (median -19.5%, range -11/-31% vs. -4.8%, +2.5/-10%, P<0.001). A clinically significant decrease was seen in one (7%) of the patients given Irb vs. five (33%) given Pro (P<0.02). The fall in mean arterial pressure was significantly higher with Irb than with Pro (median -29%, range -15/-45% vs. -4.9%, +8/-19%, P<0.02). Irb significantly modified the blood creatinine clearance (median -29 ml/m, range +9/-61 ml/m, -30, -24/-35% P<0.0001 vs. basal).
Irb offers no advantage over Pro in the control of portal hypertension. Moreover, its therapeutic profile is limited by important side effects.
背景/目的：血管紧张素II（AT-II）I型受体拮抗剂在门静脉高压治疗中的作用仍存在争议。我们测试了厄贝沙坦（Irb）与普萘洛尔（Pro）降低门静脉压力的疗效，并评估了其对全身血流动力学的影响。
34例患者被随机分为两组，分别接受每日300 mg厄贝沙坦治疗（19例）或每日40 - 120 mg普萘洛尔治疗（15例），疗程为2个月。
5例患者（26%）停用了厄贝沙坦。普萘洛尔组未发生严重副作用。平均而言，普萘洛尔组门静脉压力梯度的下降幅度显著大于厄贝沙坦组（中位数-19.5%，范围-11%/-31% vs. -4.8%，+2.5%/-10%，P<0.001）。接受厄贝沙坦治疗的患者中有1例（7%）出现了具有临床意义的下降，而接受普萘洛尔治疗的患者中有5例（33%）出现了下降（P<0.02）。厄贝沙坦导致的平均动脉压下降幅度显著高于普萘洛尔（中位数-29%，范围-15%/-45% vs. -4.9%，+8%/-19%，P<0.02）。厄贝沙坦显著改变了血肌酐清除率（中位数-29 ml/m，范围+9 ml/m/-61 ml/m，-30，-24%/-35%，与基础值相比P<0.0001）。
在控制门静脉高压方面，厄贝沙坦并不比普萘洛尔更具优势。此外，其治疗效果受到重要副作用的限制。
