卡维地洛与普萘洛尔预防肝脾型血吸虫病静脉曲张再出血的疗效及安全性比较
Carvedilol propranolol in the prevention of variceal rebleeding in hepatosplenic schistosomiasis: Efficacy and safety.
作者信息
Razafindrazoto Chantelli Iamblaudiot, Razafindrabekoto Lova Dany Ella, Hasina Laingonirina Domoina Harivonjy, Raveloson Raveloson, Rasolonjatovo Anjaramalala Sitraka, Rakotozafindrabe Andry Lalaina Rinà, Rabenjanahary Tovo Harimanana, Razafimahefa Soloniaina Hélio, Ramanampamonjy Rado Manitrala
机构信息
Unity of Gastroenterology University Hospital Joseph Raseta Befelatanana Antananarivo Madagascar.
Unity of Intensive Care University Hospital Andrainjato Fianarantsoa Madagascar.
出版信息
JGH Open. 2022 Mar 7;6(3):213-218. doi: 10.1002/jgh3.12721. eCollection 2022 Mar.
BACKGROUND AND AIM
Beta blockers combined with endoscopic variceal band ligation (EVL) is the most effective means for the prevention of variceal rebleeding. No data are available on the efficacy of carvedilol in the secondary prophylaxis of variceal bleeding in hepatosplenic schistosomiasis. The aim of this study was to evaluate the efficacy and safety of carvedilol compared to propranolol as secondary prophylaxis of variceal bleeding in hepatosplenic schistosomiasis.
METHODS
This was a prospective, randomized study over a period of 14 months from February 2019 to March 2020. All patients with portal hypertension due to schistosomiasis with at least one episode of variceal bleeding were included and randomized to the propranolol and carvedilol groups. EVL protocol was continued in both groups.
RESULTS
Sixty-one patients were eligible and randomized to propranolol ( = 30) and carvedilol ( = 31) groups. There was no significant difference in hemorrhagic recurrence between the carvedilol ( = 1) and propranolol ( = 3) groups (3.33 vs 10%; = 0.30). At 4 months, there was a significant reduction in mean arterial pressure (-4.13 mm Hg; 95% CI: -6.27 to -1.99; < 0.05) and heart rate (-12.13 bpm; 95% CI: -13.92 to -10.35; < 0.05) in the carvedilol group. There was no significant difference between the groups on the mean difference in arterial pressure. One patient in the carvedilol group had breathing difficulty. There were no adverse events in the propranolol group.
CONCLUSION
There was no significant difference in the efficacy between carvedilol and propranolol. Carvedilol may be an alternative to propranolol for secondary prophylaxis of variceal rebleeding in hepatosplenic schistosomiasis.
背景与目的
β受体阻滞剂联合内镜下静脉曲张套扎术（EVL）是预防静脉曲张再出血最有效的方法。关于卡维地洛在肝脾型血吸虫病静脉曲张出血二级预防中的疗效尚无数据。本研究的目的是评估卡维地洛与普萘洛尔相比，作为肝脾型血吸虫病静脉曲张出血二级预防的疗效和安全性。
方法
这是一项前瞻性随机研究，为期14个月，从2019年2月至2020年3月。纳入所有因血吸虫病导致门静脉高压且至少有一次静脉曲张出血发作的患者，并随机分为普萘洛尔组和卡维地洛组。两组均继续采用EVL方案。
结果
61例患者符合条件并随机分为普萘洛尔组（n = 30）和卡维地洛组（n = 31）。卡维地洛组（n = 1）和普萘洛尔组（n = 3）的出血复发率无显著差异（3.33%对10%；P = 0.30）。4个月时，卡维地洛组的平均动脉压显著降低（-4.13 mmHg；95% CI：-6.27至-1.99；P < 0.05），心率显著降低（-12.13次/分；95% CI：-13.92至-10.35；P < 0.05）。两组间动脉压平均差异无显著差异。卡维地洛组有1例患者出现呼吸困难。普萘洛尔组无不良事件发生。
结论
卡维地洛和普萘洛尔在疗效上无显著差异。卡维地洛可作为普萘洛尔的替代药物用于肝脾型血吸虫病静脉曲张再出血的二级预防。
Zotero 插件