Tsai Y T, Lee F Y, Lin H C, Chang T T, Lay C S, Wang S S, Kong C W, Lee S D, Lo K J
Department of Medicine, Veterans General Hospital, Republic of China.
Hepatology. 1989 Sep;10(3):283-7. doi: 10.1002/hep.1840100305.
We conducted a randomized controlled hemodynamic study to evaluate the effect of placebo and 20 mg isosorbide-5-mononitrate, a long-acting organic nitrate, in 19 patients with HBsAg-positive cirrhosis by the simultaneous measurement of portal venous pressure and wedged hepatic venous pressure. Baseline values for the two groups were similar. One hour after oral administration of 20 mg isosorbide-5-mononitrate in 10 patients, mean arterial pressure, mean pulmonary arterial pressure and pulmonary capillary wedge pressure significantly decreased from 92 +/- 13 (mean +/- S.D.) to 82 +/- 14 mmHg, from 12.9 +/- 4.5 to 9.3 +/- 2.4 mmHg and from 6.9 +/- 3.4 to 4.3 +/- 1.8 mmHg, respectively. However, both portal venous pressure gradient (from 18.1 +/- 3.6 to 17.5 +/- 3.0 mmHg) and hepatic venous pressure gradient (from 17.8 +/- 5.2 to 16.6 +/- 5.3 mmHg) remained unchanged during the study. In six patients who received 20 mg isosorbide-5-mononitrate twice daily for 7 days, hepatic venous pressure gradient remained unaltered as compared to basal and 1-hr values. There was no significant change in cardiac index, heart rate or systemic vascular resistance in either immediate (1-hr) or delayed (7-day) studies. Three patients (30%) developed mild headache or dizziness and two patients (20%) demonstrated systolic hypotension (less than mmHg) during the immediate study. This study shows that isosorbide-5-mononitrate appears to have no effect in treating portal hypertension in patients with HBsAg-positive cirrhosis. In addition, the isosorbide-5-mononitrate may affect the systemic circulation more than the portal circulation.
我们进行了一项随机对照血流动力学研究，通过同时测量门静脉压力和肝静脉楔压，评估安慰剂和20毫克5-单硝酸异山梨酯（一种长效有机硝酸盐）对19例HBsAg阳性肝硬化患者的影响。两组的基线值相似。在10例患者口服20毫克5-单硝酸异山梨酯1小时后，平均动脉压、平均肺动脉压和肺毛细血管楔压分别从92±13（平均值±标准差）显著降至82±14 mmHg，从12.9±4.5降至9.3±2.4 mmHg，从6.9±3.4降至4.3±1.8 mmHg。然而，在研究期间，门静脉压力梯度（从18.1±3.6降至17.5±3.0 mmHg）和肝静脉压力梯度（从17.8±5.2降至16.6±5.3 mmHg）均保持不变。在6例每天两次服用20毫克5-单硝酸异山梨酯，共7天的患者中，肝静脉压力梯度与基础值和1小时值相比保持不变。在即时（1小时）或延迟（7天）研究中，心脏指数、心率或全身血管阻力均无显著变化。在即时研究期间，3例患者（30%）出现轻度头痛或头晕，2例患者（20%）出现收缩期低血压（低于 mmHg）。本研究表明，5-单硝酸异山梨酯似乎对治疗HBsAg阳性肝硬化患者的门静脉高压无效。此外，5-单硝酸异山梨酯对全身循环的影响可能大于对门静脉循环的影响。
