Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
Biomed Res Int. 2021 Apr 26;2021:5587566. doi: 10.1155/2021/5587566. eCollection 2021.
Nonselective beta-blockers (NSBBs) are the main drug to prevent portal hypertension. It could alter free hepatic venous pressure (FHVP); however, the significance is unknown. This prospective study was to explore the change of FHVP after use of NSBBs and its predictive value for gastroesophageal varices (GOV) bleeding in cirrhotic patients. . Cirrhotic patients with medium-large GOV between September 2014 and January 2019 were enrolled. After initial hepatic venous pressure gradient (HVPG) measurement, patients received oral NSBBs. Seven days later, the secondary HVPG was examined to evaluate the FHVP alteration and hemodynamic response. The variceal bleeding between patients with FHVP increased and decreased/unchanged was compared.
A total of 74 patients were enrolled, and 62 patients completed the secondary HVPG measurement and was followed up. The cumulative bleeding rate was significantly higher in patients with FHVP increased ≥ 1.75 mmHg than those with FHVP decreased/unchanged (54.5% vs. 22.5%, = 0.021), while there was no significant difference in bleeding between HVPG responders and nonresponders (32.6% vs. 37.5%, = 0.520). For HVPG responders, variceal bleeding in patients with FHVP increased ≥ 1.75 mmHg was significantly more than that in patients with FHVP decreased/unchanged (57.9% vs. 28.6%, = 0.041). Cox regression analysis showed that change of FHVP was an independent predictor of variceal bleeding.
Increase ≥ 1.75 mmHg in FHVP responding to beta-blockers in cirrhotic patients with GOV indicates high risk of variceal bleeding. Besides HVPG response, change of FHVP should also be valued in hemodynamic evaluation to beta-blockers. This trial is registered with Chinese Clinical Trial Registry ChiCTR-IPR-17012836.
非选择性β受体阻滞剂（NSBBs）是预防门静脉高压的主要药物。它可能会改变游离肝静脉压力（FHVP）；然而，其意义尚不清楚。本前瞻性研究旨在探讨 NSBBs 使用后 FHVP 的变化及其对肝硬化患者胃食管静脉曲张（GOV）出血的预测价值。
纳入 2014 年 9 月至 2019 年 1 月期间具有中大型 GOV 的肝硬化患者。初始测量肝静脉压力梯度（HVPG）后，患者接受口服 NSBBs。7 天后，检查二次 HVPG 以评估 FHVP 变化和血流动力学反应。比较 FHVP 增加和减少/不变的患者之间的静脉曲张出血情况。
共纳入 74 例患者，其中 62 例完成了二次 HVPG 测量并进行了随访。FHVP 增加≥1.75mmHg 的患者累积出血率明显高于 FHVP 减少/不变的患者（54.5%比 22.5%，=0.021），而 HVPG 反应者和非反应者之间的出血无显著差异（32.6%比 37.5%，=0.520）。对于 HVPG 反应者，FHVP 增加≥1.75mmHg 的患者静脉曲张出血明显多于 FHVP 减少/不变的患者（57.9%比 28.6%，=0.041）。Cox 回归分析显示，FHVP 的变化是 GOV 肝硬化患者对β受体阻滞剂治疗后静脉曲张出血的独立预测因子。
对 GOV 肝硬化患者用β受体阻滞剂治疗后 FHVP 增加≥1.75mmHg 提示静脉曲张出血风险高。除 HVPG 反应外，FHVP 的变化在β受体阻滞剂血流动力学评估中也应受到重视。本试验在中国临床试验注册中心注册，注册号 ChiCTR-IPR-17012836。
