Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
Department of Cell Therapy and Tissue Engineering, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
Gut Liver. 2017 Sep 15;11(5):702-710. doi: 10.5009/gnl16478.
BACKGROUND/AIMS: Non-selective beta blockers (NSBBs) are currently the only accepted regimen for preventing portal hypertension (PHT)-related complications. However, the effect of NSBBs is insufficient in many cases. Bacterial translocation (BT) is one of the aggravating factors of PHT in cirrhosis; therefore, selective intestinal decontamination by rifaximin is a possible therapeutic option for improving PHT. We investigated whether the addition of rifaximin to propranolol therapy can improve hepatic venous pressure gradient (HVPG) response.
Sixty-four cirrhosis patients were randomly assigned to propranolol monotherapy (n=48) versus rifaximin and propranolol combination therapy (n=16). Baseline and post-treatment HVPG values, BT-related markers (lipopolysaccharide [LPS], LPS-binding protein [LBP], interleukin-6 [IL-6], and tumor necrosis factor α [TNF-α]), serological data, and adverse event data were collected. HVPG response rate was the primary endpoint.
Combination therapy was associated with better HVPG response rates than monotherapy (56.2% vs 87.5%, p=0.034). In combination therapy, posttreatment BT-related markers were significantly decreased (LPS, p=0.005; LBP, p=0.005; IL-6, p=0.005; TNF-α, p=0.047).
Rifaximin combination therapy showed an additive effect in improving PHT compared to propranolol monotherapy. These pilot data suggest that the addition of rifaximin to NSBBs could be a good therapeutic option for overcoming the limited effectiveness of NSBBs.
背景/目的：非选择性β受体阻滞剂（NSBBs）目前是预防门静脉高压（PHT）相关并发症的唯一可接受的方案。然而，在许多情况下，NSBBs 的效果并不理想。细菌易位（BT）是肝硬化 PHT 的加重因素之一；因此，利福昔明选择性肠道去污可能是改善 PHT 的一种治疗选择。我们研究了利福昔明联合普萘洛尔治疗是否可以改善肝静脉压力梯度（HVPG）反应。
64 例肝硬化患者被随机分为普萘洛尔单药治疗组（n=48）和利福昔明联合普萘洛尔治疗组（n=16）。收集基线和治疗后 HVPG 值、BT 相关标志物（脂多糖 [LPS]、LPS 结合蛋白 [LBP]、白细胞介素 6 [IL-6]和肿瘤坏死因子 α [TNF-α]）、血清学数据和不良事件数据。HVPG 反应率是主要终点。
联合治疗组的 HVPG 反应率优于单药治疗组（56.2% vs 87.5%，p=0.034）。联合治疗后，BT 相关标志物显著降低（LPS，p=0.005；LBP，p=0.005；IL-6，p=0.005；TNF-α，p=0.047）。
与普萘洛尔单药治疗相比，利福昔明联合治疗在改善 PHT 方面具有附加作用。这些初步数据表明，将利福昔明添加到 NSBBs 中可能是克服 NSBBs 疗效有限的一种很好的治疗选择。
