在严重酒精性肝炎中，使用β受体阻滞剂与急性肾损伤的发生有关。
The use of beta-blockers is associated with the occurrence of acute kidney injury in severe alcoholic hepatitis.
作者信息
Sersté Thomas, Njimi Hassane, Degré Delphine, Deltenre Pierre, Schreiber Jonas, Lepida Antonia, Trépo Eric, Gustot Thierry, Moreno Christophe
机构信息
Liver Unit, Department of Gastroenterology and Hepatopancreatology, CUB Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium.
Department of Hepatogastroenterology, CHU Saint-Pierre, Bruxelles, Belgium.
出版信息
Liver Int. 2015 Aug;35(8):1974-82. doi: 10.1111/liv.12786. Epub 2015 Feb 4.
BACKGROUND & AIMS: The beneficial effect of nonselective beta-blockers (NSBB) has recently been questioned in patients with end-stage cirrhosis. We analysed the impact of NSBB on outcomes in severe alcoholic hepatitis (AH).
METHODS
This study was based on a prospective database of patients with severe, biopsy-proven AH. Patients admitted from July, 2006 to July, 2014 were retrospectively studied. Patients were divided into two groups (with and without NSBB) and assessed for the occurrence of Acute Kidney Injury (AKI) and transplant-free mortality during a 168-day follow-up period.
RESULTS
One hundred thirty-nine patients were included, the mean Maddrey score was 71 ± 34 and 86 patients (61.9%) developed AKI. Forty-eight patients (34.5%) received NSBB. The overall 168-day transplant-free mortality was 50.5% (95%CI, 41.3-60.0%). The overall 168-day cumulative incidence of AKI was 61.9% (95%CI, 53.2-69.4%). When compared, patients with NSBB had a lower heart rate (65 ± 13 vs 92 ± 12, P < 0.0001) and a lower mean arterial pressure (MAP, 78 ± 3 vs 87 ± 5, P < 0.0001). Patients with NSBB had comparable MELD scores, Maddrey scores, and medical histories. The 168-day transplant-free mortality was 56.8% (95%CI, 41.3-69.7%) in patients with NSBB and 46.7% (95%CI, 35.0-57.6%) without NSBB (P = 0.25). The 168-day cumulative incidence of AKI was 89.6% (95%CI, 74.9-95.9%) with NSBB compared to 50.4% (95%CI: 39.0-60.7) for no NSBB (P = 0.0001). The independent factors predicting AKI were a higher MELD score and the presence of NSBB.
CONCLUSIONS
The use of NSBB in patients with severe AH is independently associated with a higher cumulative incidence of AKI.
背景与目的
非选择性β受体阻滞剂（NSBB）对终末期肝硬化患者的有益作用最近受到质疑。我们分析了NSBB对重症酒精性肝炎（AH）患者预后的影响。
方法
本研究基于一个经活检证实为重症AH患者的前瞻性数据库。对2006年7月至2014年7月收治的患者进行回顾性研究。将患者分为两组（使用NSBB组和未使用NSBB组），并在168天的随访期内评估急性肾损伤（AKI）的发生情况和无移植死亡率。
结果
共纳入139例患者，平均Maddrey评分71±34，86例患者（61.9%）发生AKI。48例患者（34.5%）使用了NSBB。168天的总体无移植死亡率为50.5%（95%可信区间，41.3 - 60.0%）。AKI的168天总体累积发生率为61.9%（95%可信区间，53.2 - 69.4%）。相比之下，使用NSBB的患者心率较低（65±13对92±12，P<0.0001），平均动脉压（MAP）较低（78±3对87±5，P<0.0001）。使用NSBB的患者MELD评分、Maddrey评分和病史相当。使用NSBB的患者168天无移植死亡率为56.8%（95%可信区间，41.3 - 69.7%），未使用NSBB的患者为46.7%（95%可信区间，35.0 - 57.6%）（P = 0.25）。使用NSBB时AKI的168天累积发生率为89.6%（95%可信区间，74.9 - 95.9%），未使用NSBB时为50.4%（95%可信区间：39.0 - 60.7）（P = 0.0001）。预测AKI的独立因素是较高的MELD评分和使用NSBB。
结论
在重症AH患者中使用NSBB与较高的AKI累积发生率独立相关。
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