Giannelli Valerio, Lattanzi Barbara, Thalheimer Ulrich, Merli Manuela
Gastroenterology Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy (Valerio Giannelli, Barbara Lattanzi, Manuela Merli).
Exeter Liver Unit, Royal Devon and Exeter Foundation Trust, Exeter, UK (Ulrich Thalheimer).
Ann Gastroenterol. 2014;27(1):20-26.
Since the original description of the effectiveness of β-blockers in lowering the portal pressure and therefore the risk of variceal bleeding, more than 500 articles in the English literature on the use of non selective β-blockers (NSBB) in cirrhosis have been published. The use of NSBB in pre-primary prophylaxis of variceal bleeding is currently not indicated. In primary prophylaxis, patients with high risk small varices or large/medium varices should receive primary prophylaxis either with NSBB or with endoscopic band ligation if there are contraindications to NSBB. For secondary prophylaxis the current recommendation is to receive a combination of NSBB and endoscopic variceal ligation. In addition to lowering portal pressure, NSBB can also reduce bacterial translocation, potentially exerting multiple beneficial effects which go beyond the reduction of bleeding risk. Carvedilol is a NSBB with intrinsic anti-α(1)-adrenergic activity, possibly more effective than propranolol in lowering portal hypertension. A potential harmful effect of propranolol in patients with cirrhosis with refractory ascites deserves further confirmation. NSBB remain the cornerstone of therapy in cirrhotic patients with portal hypertension.
自从最初描述β受体阻滞剂在降低门静脉压力以及因此降低静脉曲张出血风险方面的有效性以来，英文文献中已发表了500多篇关于在肝硬化患者中使用非选择性β受体阻滞剂（NSBB）的文章。目前不建议在静脉曲张出血的一级预防中使用NSBB。在一级预防中，小静脉曲张且风险高或中/大静脉曲张的患者，如果存在NSBB的禁忌证，应接受NSBB或内镜下套扎术进行一级预防。对于二级预防，目前的建议是接受NSBB与内镜下静脉曲张套扎术联合治疗。除了降低门静脉压力外，NSBB还可减少细菌移位，可能发挥多种有益作用，这些作用超出了降低出血风险的范畴。卡维地洛是一种具有内在抗α(1)肾上腺素能活性的NSBB，在降低门静脉高压方面可能比普萘洛尔更有效。普萘洛尔对肝硬化伴顽固性腹水患者的潜在有害作用值得进一步证实。NSBB仍然是肝硬化门静脉高压患者治疗的基石。
