小剂量普萘洛尔治疗可改善肝硬化肝性脑病患者的生存率

StephenW

Low dose of propranolol treatment is associated with better survival in cirrhotic patients with hepatic encephalopathy

Lee, Pei-Changa ,, b ,, d ,, *; Chen, Yu-Jua ,, e ,, *; Chou, Yueh-Chinga ,, e ,, h; Lee, Kuei-Chuanb ,, d; Chen, Ping-Hsienb ,, f; Kao, Wei-Yui ,, j; Huang, Yi-Hsiangb ,, d ,, c; Huo, Teh-Iaa ,, d; Lin, Han-Chiehb ,, d; Hou, Ming- Chihb ,, d; Lee, Fa-Yauhd; Wu, Jaw-Chingc ,, g; Su, Chien-Weib ,, dAuthor Information
European Journal of Gastroenterology & Hepatology: March 2020-Volume 32-Issue 3-p 365-372
doi: 10.1097 / MEG.0000000000001511

    Buy
    SDC

Abstract
Objective
The use of nonselective beta blockers in cirrhotic patients experiencing complications is controversial. We aimed to investigate the association between propranolol treatment and outcomes for cirrhotic patients with hepatic encephalopathy.
Methods
Using data from the Taiwan National Health Insurance Research Database, we identified 4754 cirrhotic patients newly diagnosed with hepatic encephalopathy between 2001 and 2010. Among them, 519 patients received propranolol treatment and the other 519 patients without exposure to propranolol were enrolled into our study, both of which were matched by sex, age, and propensity score. The Kaplan--Meier method and time-dependent--modified Cox proportional hazards models were employed for survival and multivariate-stratified analyses.
Results
The median overall survival (OS) was significantly longer in the propranolol-treated cohort than in the untreated cohort (3.46 versus 1.88 years, P <0.001). A dose-dependent increase in survival was observed (median OS: 4.49, 3.29, and 2.46 years in patients treated with propranolol more than 30, 20–30, and less than 20 mg / day, respectively [P <0.001, P = 0.001, and P = 0.079 versus the untreated group]). In addition to reduce the risk of mortality (adjusted hazard ratio, 0.58; P <0.001), propranolol also diminished the risk of sepsis-related death (adjusted hazard ratio, 0.31; P = 0.006) according to the multivariate analysis. However, the risk of circulatory or hepatic failure was nonsignificantly altered by propranolol treatment.
Conclusion
Low dose of propranolol treatment was associated with a better OS in cirrhotic patients with hepatic encephalopathy and its effects were dose dependent.

StephenW

小剂量普萘洛尔治疗可改善肝硬化肝性脑病患者的生存率

Lee，Pei-Changa，，b ,, d ,, *; Chen，Yu-Jua ,, e ,, *; Chou，Yueh-Chinga，，e ,, h; Lee，Kuei-Chuanb ,, d; Chen，Ping-Hsienb ,, f;高卫伟，j； Huang，Yi-Hsiangb ，， d，c； Huo Teh-Iaa，d； Lin，Han-Chiehb ,, d;侯明智，d；李发佑； Wu，Jaw-Chingc ,, g; Su，Chien-Weib ,, d作者信息
欧洲胃肠病学和肝病学杂志：2020年3月-第32卷-第3期-365-372
doi：10.1097 / MEG.0000000000001511

购买
数据中心

抽象
目的
在有并发症的肝硬化患者中使用非选择性β受体阻滞剂存在争议。我们旨在调查普萘洛尔治疗与肝硬化性肝性脑病患者预后之间的关联。
方法
利用台湾国家健康保险研究数据库中的数据，我们确定了2001年至2010年之间新诊断为肝性脑病的4754例肝硬化患者。其中，有519例患者接受了普萘洛尔治疗，另外519例未接受普萘洛尔治疗的患者入选了我们的研究，其中包括性别，年龄和倾向得分。 Kaplan-Meier方法和时变的Cox比例风险模型用于生存和多元分层分析。
结果
普萘洛尔治疗组的中位总生存期（OS）明显长于未治疗组（3.46对1.88年，P <0.001）。观察到剂量依赖性的生存增加（中枢心衰：分别大于30、20-30和小于20 mg /天的普萘洛尔治疗的患者分别为4.49、3.29和2.46岁[P <0.001，P = 0.001 ，相对于未治疗组，P = 0.079]。根据多变量分析，除了降低死亡风险（调整后的风险比，0.58； P <0.001）之外，普萘洛尔还降低了败血症相关死亡的风险（调整后的风险比，0.31； P = 0.006）。但是，普萘洛尔治疗不会显着改变循环或肝功能衰竭的风险。
结论
在肝硬化性脑病患者中，低剂量的普萘洛尔治疗与较好的OS有关，且其作用与剂量有关。