EASL2013]β受体阻滞剂治疗肝硬化的新机制

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在2013年欧洲肝病学会（European Association for the Study of the Liver,EASL）主办的国际肝病大会（the International Liver Congress,ILC）上，奥地利维也纳医科大学报告了一项新的临床研究数据，研究发现，非选择性β受体阻滞剂（NSBB）能有效改善肝硬化患者的胃/肠通透性，减少细菌移位，有助于降低食管静脉曲张破裂出血的风险。

       研究人员纳入50例肝硬化患者，在NSBB治疗前和治疗当中进行以下测量：
      1、肝静脉压力梯度（HVPG）评估门静脉压力
      2、蔗糖乳果糖甘露醇（SLM）测试胃和肠道通透性
      3、脂多糖结合蛋白（LBP）和白细胞介素-6的水平（IL-6）的定量检测。随访期间记录出血率和死亡率。

       研究结果如下：病人的特点：72%男性，18%有腹水，60%为酒精性病因。NSBB治疗之前，分别在72%和59%的患者中发现胃和肠道通透性异常。相对与HVPG<20mmHg患者，重度门静脉高压症患者（HVPG≥20mmHg；n=35）胃/肠通透性（尿蔗糖水平，P=0.049；蔗糖或甘露醇比值，P=0.007；肠道通透性指数，p=0.002），以及细菌移位（LBP，P=0.002；IL-6，P=0.025）标志物增加。NSBB治疗不仅导致HVPG显着减少，而且改善了胃/肠通透性，减少了细菌移位（LBP−16%，P = 0.018；IL-6−41%，P＜0.0001）。

       胃和肠道通透性异常在肝硬化患者很常见，与门脉高压的程度相关。该研究为肝硬化患者应用非选择性β受体阻滞剂治疗提供一个新的理论基础。

论文摘要：

Improvement of intestinal permeability and reducing bacterial translocation by betablocker treatment is associated with a lower risk of variceal bleeding

Introduction: Evaluation of gastrointestinal permeability and bacterial translocation in cirrhotic patients with portal hypertension (PHT) prior and after nonselective betablocker (NSBB) treatment.

Methods: 50 cirrhotic patients underwent the following measurements prior and under NSBB treatment:
i. portal pressure was assessed by the hepatic venous pressure gradient (HVPG),
ii. gastroduodenal and intestinal permeability was evaluated by the sucrose-lactulose-mannitol (SLM) test, and
iii. levels of LPS-binding protein (LBP) and interleukin-6 (IL-6) were quantified by ELISA. Bleeding rates and mortality were recorded during follow-up by clinical visits.

Results: Patient characteristics: 72% male, 18% ascites, 60% alcoholic etiology). Prior to NSBB treatment, abnormal gastroduodenal and intestinal permeability were found in 72% and 59% of patients, respectively. Patients with severe portal hypertension (HVPG ≥20mmHg;n= 35) had increased markers of gastroduodenal/intestinal permeability (urine sucrose levels p = 0.049; sucrose/mannitol ratios p = 0.007; intestinal permeability indices p = 0.002), and of bacterial translocation (LBP p = 0.002; IL-6 p = 0.025) than patients with HVPG <20mmHg. NSBB treatment
did not only result in a significant reduction in HVPG, but also in improvement of gastroduodenal/intestinal permeability and a decrease of bacterial translocation (LBP −16% p = 0.018; IL-6−41% p < 0.0001) levels These improvements were not limited to hemodynamic responders. Patients with abnormal results by the SLM test indicating abnormal gastroduodenal (p = 0.066) or intestinal permeability (p = 0.084) had a clear trend towards a higher incidence of variceal bleeding. Accordingly, patients with high LBP (p = 0.180) and/or IL-6 (p = 0.038) levels were also at increased risk of variceal bleeding during follow-up. However, these findings did not translate into an increased mortality in patients with abnormal gastroduodenal (p = 0.870) or intestinal permeability (p = 0.994), nor in patients with high levels of LBP (p = 0.571) and
IL-6 (p = 0.594).

Conclusions: Abnormal gastroduodenal and intestinal permeability are common findings in cirrhotic patients and are correlated with the degree of portal hypertension. NSBB treatment ameliorates gastroduodenal/intestinal permeability and reduces bacterial translocation, which may contribute to the reduced risk of variceal bleeding observed under NSBB treatment.

与HBV同行

学习了 ，谢谢411老师。

40更坚强

顶一个。。。。。。。。。

肝胆相照牛

顶起，虽然我看不懂

xmobe

看不懂啊

dugulvzhe

学习

sdhbq

是治疗高血压的那类药么?
因为怕高血压药伤肝，一直没敢上。
还觉得抗病毒药可能致高血压，所以一直郁闷中。