Department of Internal Medicine and Institute of Lifelong Health, Yonsei University Wonju College of Medicine, Wonju, Korea.
Gut Liver. 2007 Dec;1(2):159-64. doi: 10.5009/gnl.2007.1.2.159. Epub 2007 Dec 31.
BACKGROUND/AIMS: Propranolol can prevent variceal bleeding by ameliorating portal hypertension. We conducted this study to determine the effect of propranolol on portal hypertension and the optimal required dose in Korean cirrhotic patients.
This study prospectively evaluated 50 patients with cirrhosis who exhibited variceal bleeding. The hepatic venous pressure gradient (HVPG), portal venous flow, heart rate (HR), and blood pressure were assessed both at baseline and at 3 months after the treatment. The initial dose of propranolol (20 mg) was subsequently adjusted until the target HR was reached. Patients in whom HVPG reduced by >20% or to less than 12 mmHg were defined as responders.
Propranolol significantly (p<0.01) reduced the HVPG (-21+/-26%, mean+/-standard deviation), portal venous flow (-25+/-21%), HR (-20+/-13%), and blood pressure (-3+/-13%). Twenty-nine patients were responders, and the optimal required dose was 154.4 mg. The main complication was dizziness (24%), but this was not serious enough to require medication withdrawal.
Propranolol is safe and effective at reducing portal pressure in Korean cirrhotic patients. An effective improvement in portal hypertension requires the dose to be increased until the target HR is reached.
背景/目的:普萘洛尔可通过改善门脉高压来预防静脉曲张出血。我们进行本研究旨在确定普萘洛尔对韩国肝硬化患者的门脉高压的影响及其最佳所需剂量。
本前瞻性研究评估了 50 例有静脉曲张出血的肝硬化患者。在基线和治疗 3 个月时评估肝静脉压力梯度(HVPG)、门静脉血流、心率(HR)和血压。普萘洛尔的初始剂量(20mg)随后进行调整,直到达到目标 HR。HVPG 降低>20%或降至 12mmHg 以下的患者定义为应答者。
普萘洛尔显著降低 HVPG(-21±/-26%,平均值±标准差)、门静脉血流(-25±/-21%)、HR(-20±/-13%)和血压(-3±/-13%)(p<0.01)。29 例患者为应答者,最佳所需剂量为 154.4mg。主要并发症是头晕(24%),但并不严重,无需停药。
普萘洛尔在韩国肝硬化患者中安全且有效,可降低门脉压。为了有效改善门脉高压,需要增加剂量,直到达到目标 HR。