Fedulenkova L V
Eksp Klin Gastroenterol. 2009(5):130-7.
The effect of nebevolol, beta-blocker on the portal hypertension and renal blood flow and the safety of its use versus lisinopril, an angiotensin-converting enzyme inhibitor were examined in the patients with cirrhosis. 72 patients were examined (39 patients with cirrhosis of the liver without ascites - the 1st group and 32 patients with cirrhosis of the liver with ascites - the 2nd group. Trustworthy decrease of portal hypertension parameters (the decrease of portovenosis gradient of pressure (PPG) by 19,3% (p = 0,048) in the patients with liver cirrhosis of class A on Child-Pugh without ascites with nebevolol was revealed. The trust worthy changes of portal blood flow was not revealed in all examined patients with lisinopril. But these patients without ascites have demonstrated the improvement of the renal hemodynamic (renal functional reserve (RFR) by 56%, effective renal plasma flow (ERPF) by 17,3%). The lisinopril intake 5 mg a day declines PPG by 18,1%. The tendency of the reduction of the functional index due to the expressed hypotensive effect of nebevolol and lisinopril was revealed in all examined patients with liver cirrhosis. So it was demonstrated that for the management of the portal hypertension in the patients with liver cirrhosis is necessary to examine of functional renal condition to prevent the development of hepatorenal syndrome.
在肝硬化患者中,研究了β受体阻滞剂奈必洛尔对门静脉高压和肾血流量的影响及其与血管紧张素转换酶抑制剂赖诺普利相比使用的安全性。共检查了72例患者(39例无腹水的肝硬化患者——第1组和32例有腹水的肝硬化患者——第2组)。结果显示,在Child-Pugh A级无腹水的肝硬化患者中,使用奈必洛尔可使门静脉高压参数显著降低(门静脉压力梯度(PPG)降低19.3%,p = 0.048)。使用赖诺普利时,并非所有接受检查的患者门静脉血流均有显著变化。但这些无腹水的患者肾血流动力学有所改善(肾功能储备(RFR)提高56%,有效肾血浆流量(ERPF)提高17.3%)。每日服用5 mg赖诺普利可使PPG降低18.1%。在所有接受检查的肝硬化患者中,均发现由于奈必洛尔和赖诺普利明显的降压作用,功能指标有降低趋势。因此表明,为管理肝硬化患者的门静脉高压,有必要检查肾功能状况以预防肝肾综合征的发生。