Scheiner Bernhard, Parada-Rodriguez Diego, Bucsics Theresa, Schwabl Philipp, Mandorfer Mattias, Pfisterer Nikolaus, Riedl Florian, Sieghart Wolfgang, Ferlitsch Arnulf, Trauner Michael, Peck-Radosavljevic Markus, Reiberger Thomas
a Department of Internal Medicine III , Division of Gastroenterology and Hepatology , Medical University of Vienna , Vienna , Austria.
b Vienna Hepatic Hemodynamic Laboratory , Medical University of Vienna , Vienna , Austria.
Scand J Gastroenterol. 2017 Sep;52(9):1008-1015. doi: 10.1080/00365521.2017.1329456. Epub 2017 May 22.
Non-selective beta-blockers (NSBBs) are used for bleeding prophylaxis in cirrhotic patients with gastroesophageal varices (GEVs). Recent data suggested that NSBB treatment might increase the risk of renal dysfunction in patients with refractory ascites due to an impaired response to acute haemodynamic stress.
Retrospective longitudinal assessment of kidney function in a cohort of cirrhotic patients with GEVs with vs. without NSBB therapy. Serum creatinine (SCre), estimated glomerular filtration rate (eGFR), incidence of acute kidney injury (AKI), new onset of large volume ascites and TIPS-/transplant-free survival were compared.
Among 176 patients, 93 patients received NSBBs, while 83 did not. Most patients were male (77.8%), had alcoholic aetiology (52.3%) and compensated cirrhosis (51.1% Child-A, MELD: 12.1 ± 3.8). Over a 3-year follow-up, renal function was comparable between patients with and without NSBB treatment. Incidence of AKI was similar in NSBB vs. no-NSBB patients (p = .323). Even in potential risk groups (ascites, MAP <90 mmHg, baseline creatinine > ULN, hyponatraemia, MELD score ≥15 points, Child-Pugh B/C), there was no difference in SCre or eGFR with vs. without NSBBs (p = n.s. at 74/78 and 76/78 of analysed time points). However, multivariate analysis revealed that the presence of ascites (HR: 3.901, 95%CI: 1.352-11.251; p = .012) and pre-existing renal impairment (HR: 4.315, 95%CI: 1.054-17.672; p = .042) were independent risk factors for AKI. Importantly, NSBB use (HR: 0.319, 95%CI: 0.120-0.848; p = .022) was independently associated with improved TIPS-/transplant-free survival.
In our cohort of unselected, mostly compensated cirrhotic patients with GEVs, NSBB treatment was neither associated with worsening of kidney function nor with increased incidence of AKI. On the contrary, NSBB treatment improved TIPS-/transplant-free survival.
非选择性β受体阻滞剂（NSBBs）用于预防肝硬化合并食管胃静脉曲张（GEV）患者的出血。近期数据表明，NSBB治疗可能会增加难治性腹水患者肾功能不全的风险，原因是对急性血流动力学应激的反应受损。
对一组肝硬化合并GEV且接受或未接受NSBB治疗的患者进行肾功能的回顾性纵向评估。比较血清肌酐（SCre）、估算肾小球滤过率（eGFR）、急性肾损伤（AKI）的发生率、新发大量腹水以及无经颈静脉肝内门体分流术（TIPS）/移植的生存率。
176例患者中，93例接受了NSBBs治疗，83例未接受。大多数患者为男性（77.8%），病因是酒精性（52.3%），且为代偿期肝硬化（51.1%为Child - A级，终末期肝病模型（MELD）评分：12.1±3.8）。在3年的随访中，接受和未接受NSBB治疗的患者肾功能相当。NSBB治疗组与未接受NSBB治疗组的AKI发生率相似（p = 0.323）。即使在潜在风险组（腹水、平均动脉压<90 mmHg、基线肌酐>正常上限、低钠血症、MELD评分≥15分、Child - Pugh B/C级）中，接受与未接受NSBB治疗的患者在SCre或eGFR方面也没有差异（在分析的时间点中，74/78和76/78时p值无统计学意义）。然而，多因素分析显示，腹水的存在（风险比（HR）：3.901，95%置信区间（CI）：1.352 - 11.251；p = 0.012）和既往存在的肾功能损害（HR：4.315，95%CI：1.054 - 17.672；p = 0.042）是AKI的独立危险因素。重要的是，使用NSBB（HR：0.319，95%CI：0.120 - 0.848；p = 0.022）与改善无TIPS/移植生存率独立相关。
在我们这组未经过选择、大多为代偿期肝硬化合并GEV的患者中，NSBB治疗既不与肾功能恶化相关，也不与AKI发生率增加相关。相反，NSBB治疗改善了无TIPS/移植生存率。
