Joshi Amey, Raja Hafsa Arshad Azam, Roy Poulami, Latif Fakhar, Reji Rahul George, Deb Novonil, Mui Ryan K, Shady Ahmed
Department of Internal Medicine, Sparrow Hospital-Michigan State University, East Lansing, Michigan, USA.
Rawalpindi Medical University, Rawalpindi, Pakistan.
J Gastroenterol Hepatol. 2025 Jun;40(6):1409-1418. doi: 10.1111/jgh.16999. Epub 2025 May 19.
Nonselective beta-blockers, such as propranolol and carvedilol, are used to prevent first decompensation in patients with clinically significant portal hypertension.
We performed a systematic literature search of English language articles from inception in PubMed, Medline, and Cochrane databases to compare the effect of carvedilol and propranolol on systemic and splanchnic hemodynamics. Mean differences were pooled using a random-effect model, and a p-value of < 0.05 was considered statistically significant.
Seven RCTs with a total of 351 patients were involved in the final analysis. Reduction in hepatic venous pressure gradient was significantly greater in the carvedilol group (MD = -0.76, 95% CI = -1.45 to -0.08; p = 0.03). Decrease in systemic vascular resistance and mean arterial pressure was significantly greater in the carvedilol group ([MD = -190.55, 95% CI = -307.5 to -73.58; p = 0.001] and [MD = -3.65, 95% CI = -5.94 to -1.36; p = 0.002], respectively). Decrease in cardiac output was greater in the propranolol group (MD = 0.92, 95% CI = 0.45-1.38; p = 0.004). Decrease in hepatic blood flow and right atrial pressure appeared to be greater in the propranolol group; however, this did not reach statistical significance ([MD = 0.13, 95% CI = -0.06 to 0.32; p = 0.17] and [MD = 0.28, 95% CI = -0.27 to 0.83; p = 0.32], respectively). Decrease in mean pulmonary arterial pressure appeared to be greater in the carvedilol group; however, this was not statistically significant (MD = -0.75, 95% CI = -1.60 to 0.10; p = 0.08). There was no difference in incidence of rebleeding, shortness of breath, hepatic encephalopathy, and hypotension between the two groups.
Carvedilol demonstrated a significantly greater reduction in HVPG, SVR, and MAP compared to propranolol, with no significant difference in adverse effects.
非选择性β受体阻滞剂，如普萘洛尔和卡维地洛，用于预防具有临床显著意义的门静脉高压患者的首次失代偿。
我们对PubMed、Medline和Cochrane数据库中自创建以来的英文文章进行了系统的文献检索，以比较卡维地洛和普萘洛尔对全身和内脏血流动力学的影响。使用随机效应模型汇总平均差异，p值<0.05被认为具有统计学意义。
最终分析纳入了7项随机对照试验，共351例患者。卡维地洛组肝静脉压力梯度的降低显著更大（MD=-0.76，95%CI=-1.45至-0.08；p=0.03）。卡维地洛组全身血管阻力和平均动脉压的降低显著更大（分别为[MD=-190.55，95%CI=-307.5至-73.58；p=0.001]和[MD=-3.65，95%CI=-5.94至-1.36；p=0.002]）。普萘洛尔组心输出量的降低更大（MD=0.92，95%CI=0.45-1.38；p=0.004）。普萘洛尔组肝血流量和右心房压力的降低似乎更大；然而，这未达到统计学意义（分别为[MD=0.13，95%CI=-0.06至0.32；p=0.17]和[MD=0.28，95%CI=-0.27至0.83；p=0.32]）。卡维地洛组平均肺动脉压的降低似乎更大；然而，这无统计学意义（MD=-0.75，95%CI=-1.60至0.10；p=0.08）。两组之间再出血、呼吸急促、肝性脑病和低血压的发生率无差异。
与普萘洛尔相比，卡维地洛在降低肝静脉压力梯度、全身血管阻力和平均动脉压方面显著更大，且不良反应无显著差异。
