门静脉高压症的临床药理学。
Clinical pharmacology of portal hypertension.
机构信息
Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street, LMP 1080, New Haven, CT 06520, USA.
出版信息
Gastroenterol Clin North Am. 2010 Sep;39(3):681-95. doi: 10.1016/j.gtc.2010.08.015.
Abstract
Portal hypertension is an increase in pressure in the portal vein and its tributaries. It is defined as a portal pressure gradient (the difference in pressure between the portal vein and the hepatic veins) greater than 5 mm Hg. Although this gradient defines portal hypertension, a gradient of 10 mm Hg or greater defines clinically significant portal hypertension, because this pressure gradient predicts the development of varices, decompensation of cirrhosis, and hepatocellular carcinoma. The most direct consequence of portal hypertension is the development of gastroesophageal varices that may rupture and lead to the development of variceal hemorrhage. This article reviews the pathophysiologic bases of the different pharmacologic treatments for portal hypertension in patients with cirrhosis and places them in the context of the natural history of varices and variceal hemorrhage.
摘要
门静脉高压症是门静脉及其属支内压力增高。门静脉高压症定义为门静脉压力梯度（门静脉与肝静脉之间的压力差）大于 5mmHg。虽然该梯度定义了门静脉高压症，但 10mmHg 或更大的梯度定义了临床显著的门静脉高压症，因为该压力梯度预测了静脉曲张的发展、肝硬化失代偿和肝细胞癌。门静脉高压症最直接的后果是胃食管静脉曲张的发展，静脉曲张可能破裂并导致静脉曲张出血。本文综述了肝硬化患者不同药理学治疗门静脉高压症的病理生理基础，并将其置于静脉曲张和静脉曲张出血的自然病程背景下。
相似文献
1
Clinical pharmacology of portal hypertension.
Gastroenterol Clin North Am. 2010 Sep;39(3):681-95. doi: 10.1016/j.gtc.2010.08.015.
2
Pharmacologic therapy of portal hypertension.
Clin Liver Dis. 2006 Aug;10(3):563-81, ix. doi: 10.1016/j.cld.2006.08.007.
3
Variceal bleeding: pharmacological therapy.
Dig Dis. 2005;23(1):18-29. doi: 10.1159/000084722.
4
Pharmacologic therapy for gastrointestinal bleeding due to portal hypertension and esophageal varices.
Curr Gastroenterol Rep. 2006 Feb;8(1):7-13. doi: 10.1007/s11894-006-0058-9.
5
The pharmacological therapy of portal hypertension.
Adv Intern Med. 1986;31:341-58.
6
Pharmacologic treatment of portal hypertension.
Gastroenterol Clin North Am. 1992 Mar;21(1):15-40.
7
[Pathophysiological and pharmacotherapeutic aspects of portal hypertension].
Schweiz Med Wochenschr. 1993 Jan 13;123(1-2):3-13.
8
[Drug therapy for the treatment of portal hypertension].
Nihon Geka Gakkai Zasshi. 1996 Jan;97(1):89-97.
9
Preventing the development of varices in cirrhosis.
J Clin Gastroenterol. 2007 Nov-Dec;41 Suppl 3:S300-4. doi: 10.1097/MCG.0b013e318157c63d.
10
[Importance of drug treatment to lower portal pressure in the therapy of variceal bleeding].
Dtsch Med Wochenschr. 2009 Sep;134(37):1823-7. doi: 10.1055/s-0029-1237518. Epub 2009 Sep 2.
引用本文的文献
1
Early Experience with Surgical Management of Non-Cirrhotic Portal Hypertension in Nigeria: Report from a Single Centre.
J West Afr Coll Surg. 2025 Apr-Jun;15(2):176-180. doi: 10.4103/jwas.jwas_10_24. Epub 2024 Jul 18.
2
From Pathophysiology to Practice: Evolving Pharmacological Therapies, Clinical Complications, and Pharmacogenetic Considerations in Portal Hypertension.
Metabolites. 2025 Jan 23;15(2):72. doi: 10.3390/metabo15020072.
3
Management Outcomes of Variceal Bleeding in Northern Tanzania: Insights From a Single-Center Retrospective Analysis.
JGH Open. 2024 Dec 30;9(1):e70088. doi: 10.1002/jgh3.70088. eCollection 2025 Jan.
4
Predictive factors of portal hypertensive enteropathy exacerbations based on long-term outcomes.
BMC Gastroenterol. 2024 Aug 26;24(1):287. doi: 10.1186/s12876-024-03377-7.
5
How to manage splanchnic vein thrombosis in patients with liver disease.
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):281-288. doi: 10.1182/hematology.2023000481.
6
Sudden Death Caused by Gastroesophageal Varices Rupture: Insights From an Autopsy-Based Case Series Unraveling the Pathological Events.
Cureus. 2023 Sep 28;15(9):e46166. doi: 10.7759/cureus.46166. eCollection 2023 Sep.
7
Current and investigational drugs in early clinical development for portal hypertension.
Front Med (Lausanne). 2022 Oct 10;9:974182. doi: 10.3389/fmed.2022.974182. eCollection 2022.
8
Future Pharmacological Therapies of Portal Hypertension.
Curr Hepatol Rep. 2019 Mar;18(1):36-48. doi: 10.1007/s11901-019-00448-2. Epub 2019 Feb 19.
9
β-arrestin-2 predicts the clinical response to β-blockers in cirrhotic portal hypertension patients: A prospective study.
World J Hepatol. 2022 Feb 27;14(2):429-441. doi: 10.4254/wjh.v14.i2.429.
10
Pathophysiology and Management of Variceal Bleeding.
Drugs. 2021 Apr;81(6):647-667. doi: 10.1007/s40265-021-01493-2. Epub 2021 Mar 12.
本文引用的文献
1
Renin-angiotensin-aldosterone inhibitors in the reduction of portal pressure: a systematic review and meta-analysis.
J Hepatol. 2010 Aug;53(2):273-82. doi: 10.1016/j.jhep.2010.03.013. Epub 2010 May 21.
2
NCX-1000, a nitric oxide-releasing derivative of UDCA, does not decrease portal pressure in patients with cirrhosis: results of a randomized, double-blind, dose-escalating study.
Am J Gastroenterol. 2010 May;105(5):1094-101. doi: 10.1038/ajg.2009.661. Epub 2009 Nov 17.
3
Clinical significance of worsening portal hypertension during long-term medical treatment in patients with cirrhosis who had been classified as early good-responders on haemodynamic criteria.
J Hepatol. 2010 Jan;52(1):45-53. doi: 10.1016/j.jhep.2009.10.014. Epub 2009 Oct 23.
4
Predicting early mortality after acute variceal hemorrhage based on classification and regression tree analysis.
Clin Gastroenterol Hepatol. 2009 Dec;7(12):1347-54. doi: 10.1016/j.cgh.2009.08.011. Epub 2009 Aug 21.
5
A randomized, controlled trial of banding ligation plus drug therapy versus drug therapy alone in the prevention of esophageal variceal rebleeding.
J Gastroenterol Hepatol. 2009 Jun;24(6):982-7. doi: 10.1111/j.1440-1746.2009.05792.x.
6
Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed.
Hepatology. 2009 Sep;50(3):825-33. doi: 10.1002/hep.23045.
7
Prognostic value of acute hemodynamic response to i.v. propranolol in patients with cirrhosis and portal hypertension.
J Hepatol. 2009 Aug;51(2):279-87. doi: 10.1016/j.jhep.2009.04.015. Epub 2009 May 24.
8
Addition of propranolol and isosorbide mononitrate to endoscopic variceal ligation does not reduce variceal rebleeding incidence.
Gastroenterology. 2009 Sep;137(3):892-901, 901.e1. doi: 10.1053/j.gastro.2009.05.049. Epub 2009 May 27.
9
Early identification of haemodynamic response to pharmacotherapy is essential for primary prophylaxis of variceal bleeding in patients with 'high-risk' varices.
Aliment Pharmacol Ther. 2009 Jul;30(1):48-60. doi: 10.1111/j.1365-2036.2009.04015.x. Epub 2009 Apr 8.
10
Acute hemodynamic response to beta-blockers and prediction of long-term outcome in primary prophylaxis of variceal bleeding.
Gastroenterology. 2009 Jul;137(1):119-28. doi: 10.1053/j.gastro.2009.03.048. Epub 2009 Apr 1.
Zotero 插件