Baik Soon Koo
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, Ilsan-dong, Wonju, Korea.
Korean J Gastroenterol. 2005 Jun;45(6):381-6.
Portal hypertension as a consequence of liver cirrhosis is responsible for serious complications such as variceal bleeding, ascites and hepatic encephalopathy. Successful pharmacological treatment of portal hypertension can prevent the risk of the variceal bleeding, and contribute to reduce the morbidity and mortality in patients with liver cirrhosis. To identify the effect of drugs on portal hypertension, portal pressure was evaluated accurately before and after the drug administration. The hepatic venous pressure gradient has been accepted as the gold-standard method for assessing the severity of portal hypertension and the response to drug treatment. The mean hepatic venous pressure gradient was 15.1+/-5.4 mmHg in Korean cirrhotic patients who had experienced variceal bleeding. Non-selective beta blockers are the treatment of choice for primary and secondary prevention of variceal bleeding. The dose of propranolol should be subsequently adjusted until the resting heart rate had been reduced by 25% or less than 55 beats per minute. It has been reported that the optimal dose of propranolol is variable due to racial differences in cardiovascular receptor sensitivity. In Korean patients with portal hypertension and liver cirrhosis, the mean required dose of propranolol to reach target heart rate was 165 mg (range; 80-280 mg). This review covers mainly the results of the pharmacological therapy of portal hypertension in Korean cirrhotic patients.
肝硬化导致的门静脉高压会引发诸如静脉曲张破裂出血、腹水和肝性脑病等严重并发症。成功的门静脉高压药物治疗可预防静脉曲张破裂出血风险,并有助于降低肝硬化患者的发病率和死亡率。为确定药物对门静脉高压的影响,在给药前后准确评估门静脉压力。肝静脉压力梯度已被公认为评估门静脉高压严重程度及药物治疗反应的金标准方法。在经历过静脉曲张破裂出血的韩国肝硬化患者中,平均肝静脉压力梯度为15.1±5.4 mmHg。非选择性β受体阻滞剂是预防静脉曲张破裂出血的一线和二线治疗选择。随后应调整普萘洛尔剂量,直至静息心率降低25%或低于每分钟55次。据报道,由于心血管受体敏感性的种族差异,普萘洛尔的最佳剂量因人而异。在患有门静脉高压和肝硬化的韩国患者中,达到目标心率所需的普萘洛尔平均剂量为165 mg(范围:80 - 280 mg)。本综述主要涵盖韩国肝硬化患者门静脉高压药物治疗的结果。