Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria; Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria; Christian Doppler Lab for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria.
Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria; Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria; Christian Doppler Lab for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria.
Clin Liver Dis. 2021 May;25(2):311-326. doi: 10.1016/j.cld.2021.01.004. Epub 2021 Mar 10.
Nonselective beta-blockers represent the mainstay of medical therapy in the prophylaxis of variceal bleeding and rebleeding in patients with portal hypertension. Their efficacy has been demonstrated by numerous trials; however, there exist safety concerns in advanced disease, such as in patients with refractory ascites. Importantly, nonselective beta-blockers also exert nonhemodynamic beneficial effects that may contribute to a prolonged decompensation-free survival, as recently shown in the PREDESCI trial. This review summarizes the current evidence on nonselective beta-blocker therapy and proposes a tailored, patient-centered approach for the use of nonselective beta-blockers in patients with portal hypertension.
非选择性β受体阻滞剂是门静脉高压症患者预防静脉曲张出血和再出血的主要医学治疗方法。大量试验已经证明了它们的疗效；然而，在晚期疾病中存在安全性问题，例如在难治性腹水患者中。重要的是，非选择性β受体阻滞剂还具有非血流动力学的有益作用，这可能有助于延长无失代偿生存时间，正如最近的 PREDESCI 试验所示。本文综述了非选择性β受体阻滞剂治疗的现有证据，并提出了一种针对门静脉高压患者使用非选择性β受体阻滞剂的个体化、以患者为中心的方法。
