β受体阻滞剂降低病因治疗后肝硬化和持续性门静脉高压患者的首次失代偿发生率。
Beta-Blockers Lower First Decompensation in Patients With Cirrhosis and Enduring Portal Hypertension After Etiological Treatment.
作者信息
Turco Laura, Taru Madalina-Gabriela, Vitale Giovanni, Stefanescu Horia, Mirici Cappa Federica, Berardi Sonia, Baldan Anna, Di Donato Roberto, Pianta Paolo, Vero Vittoria, Vizioli Luca, Procopciuc Lucia Maria, Procopet Bogdan, Morelli Maria Cristina, Piscaglia Fabio
机构信息
Internal Medicine Unit for the Treatment of Severe Organ Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Hepatology Department, Regional Institute of Gastroenterology and Hepatology Octavian Fodor, Cluj-Napoca, Romania; Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
出版信息
Clin Gastroenterol Hepatol. 2025 May;23(6):987-996.e8. doi: 10.1016/j.cgh.2024.08.012. Epub 2024 Aug 30.
BACKGROUND AND AIMS
Non-selective beta-blockers (NSBBs) can lower the risk of first decompensation in patients with cirrhosis and clinically significant portal hypertension (CSPH) (identified by a hepatic venous pressure gradient ≥10 mm Hg) with active etiology. Our aim was to examine the effect of NSBBs on first decompensation occurrence in patients with cirrhosis and enduring CSPH after etiological treatment.
METHODS
Patients with compensated cirrhosis and clinical evidence of CSPH (gastroesophageal varices [GEVs] and/or spontaneous portosystemic collaterals [SPSSs]) after 2 years from etiological treatment. The primary endpoint was first decompensation (occurrence of variceal bleeding, ascites, or hepatic encephalopathy) in patients on NSBBs vs off NSBBs.
RESULTS
The final cohort included 406 patients. Baseline characteristics of patients on NSBBs (n = 187) and off NSBBs (n = 219) were comparable, except for signs of portal hypertension that were more pronounced in the on-NSBBs group. During a mean follow-up of 32 months, 127 (31%) patients decompensated, with ascites being the most common (77%) decompensating event. Decompensation rates were lower in patients on NSBBs (16% vs 44%; P < .0001). The benefit of NSBBs on decompensation was maintained in patients with small GEVs (17% vs 43%; P < .0001), in those with spontaneous portosystemic shunt only (8% vs 43%; P = .003), and in each different etiology, including hepatitis C virus-cured cirrhosis (9% vs 32%; P < .0001). At Cox regression analysis, hemoglobin, Child-Pugh, Model for End-Stage Liver Disease-Sodium, diabetes at baseline, and previous bacterial infections were independent predictors of decompensation, while NSBBs use had a protective effect (hazard ratio, 0.32; 95% confidence interval, 0.20-0.49; P < .0001). NSBBs use significantly reduced bacterial infection rates (hazard ratio, 0.36; 95% confidence interval, 0.22-0.58; P < .0001).
CONCLUSION
NSBBs decrease the risk of first decompensation in patients with cirrhosis and enduring CSPH after etiological treatment.
背景与目的
非选择性β受体阻滞剂（NSBBs）可降低肝硬化且伴有活动性病因、临床显著门静脉高压（CSPH，通过肝静脉压力梯度≥10 mmHg确定）患者首次失代偿的风险。我们的目的是研究NSBBs对病因治疗后肝硬化且持续存在CSPH患者首次失代偿发生情况的影响。
方法
病因治疗2年后出现代偿期肝硬化且有CSPH临床证据（食管胃静脉曲张[GEVs]和/或自发性门体分流[SPSSs]）的患者。主要终点是使用NSBBs与未使用NSBBs患者的首次失代偿（静脉曲张出血、腹水或肝性脑病的发生）情况。
结果
最终队列包括406例患者。使用NSBBs组（n = 187）和未使用NSBBs组（n = 219）患者的基线特征具有可比性，但门静脉高压体征在使用NSBBs组更为明显。在平均32个月的随访期间，127例（31%）患者出现失代偿，腹水是最常见的（77%）失代偿事件。使用NSBBs的患者失代偿率较低（16%对44%；P <.0001）。NSBBs对失代偿的益处在小GEV患者（17%对43%；P <.0001）、仅存在自发性门体分流的患者（8%对43%；P =.003）以及每种不同病因的患者中均得以维持，包括丙型肝炎病毒治愈后的肝硬化患者（9%对32%；P <.0001）。在Cox回归分析中，血红蛋白、Child-Pugh评分、终末期肝病模型-钠、基线时的糖尿病以及既往细菌感染是失代偿的独立预测因素，而使用NSBBs具有保护作用（风险比，0.32；95%置信区间，0.20 - 0.49；P <.
Zotero 插件