β受体阻滞剂可改善窦前性门静脉高压。
β-Blockers Improve Presinusoidal Portal Hypertension.
机构信息
Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99; C116, 8000, Aarhus, Denmark.
Department of Radiology, Aarhus University Hospital, 8000, Aarhus, Denmark.
出版信息
Dig Dis Sci. 2018 Nov;63(11):3153-3157. doi: 10.1007/s10620-018-5186-1. Epub 2018 Jul 12.
BACKGROUND
Presinusoidal portal hypertension is a clinically important cause of gastric and gastroesophageal varices. Whereas β-blockers have an established prophylactic role against bleeding from esophageal and gastric varices in portal hypertension due to cirrhosis, the effect on presinusoidal portal hypertension is unknown.
AIMS
To evaluate the hemodynamic effect of β-blockers in non-cirrhotic patients with presinusoidal portal hypertension.
METHODS
We measured the blood pressure gradient from spleen pulp to free hepatic vein in 12 patients with presinusoidal portal hypertension by combined hepatic vein catheterization and spleen pulp puncture while on and off β-blocker treatment (random sequence).
RESULTS
The β-blockers reduced the gradient from a mean off-treatment value of 32 mm Hg to a on-treatment value of 26 mm Hg (P < 0.05) with a reduction of at least 20% in five patients (42%).
CONCLUSIONS
β-blocker treatment caused a clinically significant reduction in the pressure gradient from spleen pulp to the free hepatic vein. This finding supports the recommendation for prophylactic β-blockage in patients with presinusoidal portal hypertension.
背景
窦前性门静脉高压是胃和胃食管静脉曲张的一个重要临床病因。β受体阻滞剂在肝硬化引起的门静脉高压症中，对食管和胃静脉曲张出血具有明确的预防作用，但其对窦前性门静脉高压的作用尚不清楚。
目的
评估β受体阻滞剂在非肝硬化窦前性门静脉高压患者中的血流动力学效应。
方法
我们通过联合肝静脉导管插入术和脾髓穿刺术，在 12 例窦前性门静脉高压患者中测量了从脾髓到游离肝静脉的血压梯度，同时进行β受体阻滞剂治疗（随机顺序）。
结果
β受体阻滞剂使梯度从治疗前的平均 32mmHg 降至治疗后的 26mmHg（P<0.05），其中 5 例（42%）至少降低了 20%。
结论
β受体阻滞剂治疗可使脾髓至游离肝静脉的压力梯度显著降低。这一发现支持对窦前性门静脉高压患者预防性应用β受体阻滞剂的建议。
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