De Binay K, Bandyopadhyay Kausik, Das Tapas K, Das Debasish, Biswas Pranab K, Majumdar Debabrata, Mandal Sanjay K, Ray Sujay, Dasgupta Sanjay
Department of Medicine, Institute of Post Graduate Medical Education and Research, Calcutta, India.
Am J Gastroenterol. 2003 Jun;98(6):1371-6. doi: 10.1111/j.1572-0241.2003.07497.x.
Losartan, an angiotensin II receptor blocker, has portal hypotensive effects. This study evaluates the effect of losartan on portal pressure after 14 days and compares it with that of propranolol.
A total of 39 individuals with cirrhosis were randomized into two groups of 19 and 20 patients each and were treated with losartan and propranolol, respectively. Hepatic venous pressure gradient was measured at baseline and on day 14 of therapy. Responders to therapy had hepatic venous pressure gradient reduction of >/=20% of baseline value.
With losartan, 15 of 19 (78.94%) patients were responders and with propranolol, nine of 20 (45%) patients were responders (p < 0.05). Although the hepatic venous pressure gradient reduction (i.e., percentage from baseline) with losartan (26.74 +/- 21.7%) was higher than with propranolol (14.52 +/- 32%), the difference was not significant. The reduction in hepatic venous pressure gradient with losartan was contributed mainly by a significant drop of wedge hepatic venous pressure from 32.42 +/- 6.61 mm of Hg to 28.31 +/- 5.09 mm of Hg (p < 0.05) compared to that with propranolol, which was from 34.55 +/- 5.41 mm of Hg to 32.75 +/- 8.13 mm of Hg (p > 0.05). Responders among alcohol-abusing patients were significantly higher with losartan (81.8%) compared to those on propranolol (27.2%; p < 0.05). In the losartan group, all seven nonascitic cirrhotic individuals, as compared with two of five in the propranolol group, responded to the drugs. During the study, no significant side effects were observed in either group (who were not receiving diuretics) or in follow-up with diuretics.
Losartan is as effective as propranolol in reducing portal pressure in cirrhotic patients who are not receiving diuretics. Losartan is also superior to propranolol for achieving target level hepatic venous gradient for prevention of variceal bleeding in nonascitic and alcohol-abusing cirrhotic patients.
氯沙坦是一种血管紧张素II受体阻滞剂，具有降低门静脉压力的作用。本研究评估氯沙坦治疗14天后对门静脉压力的影响，并与普萘洛尔进行比较。
总共39例肝硬化患者被随机分为两组，每组分别为19例和20例，分别接受氯沙坦和普萘洛尔治疗。在治疗基线和第14天测量肝静脉压力梯度。治疗有效者肝静脉压力梯度降低幅度≥基线值的20%。
使用氯沙坦治疗的19例患者中有15例（78.94%）有效，使用普萘洛尔治疗的20例患者中有9例（45%）有效（p<0.05）。虽然氯沙坦治疗后肝静脉压力梯度降低幅度（即相对于基线的百分比）（26.74±21.7%）高于普萘洛尔（14.52±32%），但差异无统计学意义。与普萘洛尔相比，氯沙坦治疗后肝静脉压力梯度的降低主要是由于肝静脉楔压从32.42±6.61mmHg显著降至28.31±5.09mmHg（p<0.05），而普萘洛尔治疗后肝静脉楔压从34.55±5.41mmHg降至32.75±8.13mmHg（p>0.05）。与使用普萘洛尔的患者（27.2%；p<0.05）相比，滥用酒精的患者中使用氯沙坦治疗的有效者比例显著更高（81.8%）。在氯沙坦组中，所有7例非腹水型肝硬化患者均对药物有反应，而普萘洛尔组的5例患者中只有2例有反应。在研究期间，两组（未接受利尿剂治疗者）以及接受利尿剂治疗后的随访中均未观察到明显的副作用。
在未接受利尿剂治疗的肝硬化患者中，氯沙坦降低门静脉压力的效果与普萘洛尔相当。在非腹水型和滥用酒精的肝硬化患者中，氯沙坦在达到预防静脉曲张出血的目标肝静脉梯度方面也优于普萘洛尔。
