Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Clin Mol Hepatol. 2012 Jun;18(2):203-12. doi: 10.3350/cmh.2012.18.2.203. Epub 2012 Jun 26.
BACKGROUND/AIMS: Nonselective β-blockers (NSBBs), such as propranolol, reportedly exert a pleiotropic effect in liver cirrhosis. A previous report suggested that survival was higher in patients receiving adjusted doses of NSBBs than in ligation patients. This study investigated whether low-dose NSBB medication has beneficial effects in patients with liver cirrhosis, especially in terms of overall survival.
We retrospectively studied 273 cirrhotic patients (199 males; age 53.6±10.2 years, mean±SD) who visited our institution between March 2003 and December 2007; follow-up data were collected until June 2011. Among them, 138 patients were given a low-dose NSBB (BB group: propranolol, 20-60 mg/day), and the remaining 135 patients were not given an NSBB (NBB group). Both groups were stratified randomly according to Child-Turcotte-Pugh (CTP) classification and age.
The causes of liver cirrhosis were alcohol (n=109, 39.9%), hepatitis B virus (n=125, 45.8%), hepatitis C virus (n=20, 7.3%), and cryptogenic (n=19, 7.0%). The CTP classes were distributed as follows: A, n=116, 42.5%; B, n=126, 46.2%; and C, n=31, 11.4%. Neither the overall survival (P=0.133) nor the hepatocellular carcinoma (HCC)-free survival (P=0.910) differed significantly between the BB and NBB groups [probability of overall survival at 4 years: 75.1% (95% CI=67.7-82.5%) and 81.2% (95% CI=74.4-88.0%), respectively; P=0.236]. In addition, the delta CTP score did not differ significantly between the two groups.
Use of low-dose NSBB medication in patients with liver cirrhosis is not indicated in terms of overall and HCC-free survival.
背景/目的：普萘洛尔等非选择性β受体阻滞剂（NSBBs）据称在肝硬化中有多种作用。先前的报告表明，接受调整剂量 NSBBs 治疗的患者的生存率高于结扎患者。本研究旨在探讨低剂量 NSBB 药物治疗肝硬化患者是否有益，特别是在总生存率方面。
我们回顾性研究了 2003 年 3 月至 2007 年 12 月期间来我院就诊的 273 例肝硬化患者（男性 199 例；年龄 53.6±10.2 岁，均值±标准差）；随访数据收集至 2011 年 6 月。其中，138 例患者给予低剂量 NSBB（BB 组：普萘洛尔，20-60mg/天），其余 135 例患者未给予 NSBB（NBB 组）。两组根据 Child-Turcotte-Pugh（CTP）分类和年龄进行随机分层。
肝硬化的病因是酒精（n=109，39.9%）、乙型肝炎病毒（n=125，45.8%）、丙型肝炎病毒（n=20，7.3%）和不明原因（n=19，7.0%）。CTP 分级分布如下：A 级，n=116，42.5%；B 级，n=126，46.2%；C 级，n=31，11.4%。BB 组和 NBB 组的总生存率（P=0.133）和肝细胞癌（HCC）无复发生存率（P=0.910）无显著差异[4 年总生存率的概率：75.1%（95%CI=67.7-82.5%）和 81.2%（95%CI=74.4-88.0%），P=0.236]。此外，两组间 delta CTP 评分无显著差异。
在总生存率和 HCC 无复发生存率方面，肝硬化患者使用低剂量 NSBB 药物治疗并无指征。
