2021 年 7 月 28 日 二甲双胍与安慰剂对肝硬化和门静脉高压患

StephenW

发表于胃肠病学期刊扫描/研究 · 2021 年 7 月 28 日二甲双胍与安慰剂对肝硬化和门静脉高压患者的门静脉压力影响消化药理学与治疗学带回家的消息    这是一项有趣的研究，其中作者评估了 32 名肝硬化患者在测量门静脉压力之前立即使用二甲双胍的情况。    与安慰剂组相比，二甲双胍组的肝静脉压力梯度 (HVPG) 平均降低了 16%。在基线 HVPG > 12 mmHg 的患者中，该组中有 46% 的患者出现临床显着降低。需要进一步研究来阐明二甲双胍在门脉高压中的作用。– Natasha VonRoenn，医学博士抽象的该摘要可在出版商的网站上找到。背景门脉高压是肝硬化患者临床失代偿的主要决定因素。在临床前数据中，二甲双胍可降低门静脉压力，但没有这种有益效果的临床数据。目标管理系统研究二甲双胍对肝静脉压力梯度（HVPG）和肝脏灌注的急性影响。方法在一项随机、双盲研究设计中，我们调查了 32 名肝硬化患者在服用 1000 毫克二甲双胍（n = 16）或安慰剂（n = 16）之前和之后 90 分钟。进行肝静脉导管插入术以评估 HVPG 和吲哚菁绿 (ICG) 输注以研究肝血流量。结果二甲双胍组 HVPG 的平均相对变化为 -16%（95% CI：-28% 至 -4%），而安慰剂组为 4%（95% CI：-6% 至 14%）（时间 ×群体互动，P = 0.008）。在基线 HVPG ≥ 12 mmHg 的患者中，在 46% (6/13) 的二甲双胍治疗组和 8% (1/ 13) 安慰剂治疗的患者 (P = 0.07)。各组之间的全身血压、心率、肝脏血浆和血流量、肝脏 ICG 清除率、肝脏 O2 摄取或炎症标志物没有变化或差异。结论单次口服二甲双胍剂量可迅速降低门静脉高压患者的 HVPG，而不会影响全身或肝脏血流动力学或炎症生物标志物。这为安全和廉价的治疗选择提供了一个有前景的前景，应该在更大规模的临床研究中对肝硬化和门静脉高压患者的长期结果进行研究。

StephenW

Published in Gastroenterology

Journal Scan / Research · July 28, 2021
Portal Pressure Effects of Metformin vs Placebo in Patients With Cirrhosis and Portal Hypertension

Alimentary Pharmacology & Therapeutics

TAKE-HOME MESSAGE

    This is an interesting study in which the authors evaluated the administration of metformin immediately before measuring portal pressures in 32 patients with cirrhosis.
    A 16% mean reduction in hepatic venous pressure gradient (HVPG) was seen in the metformin group compared with the placebo group. In patients with a baseline HVPG >12 mm Hg, clinically significant reductions were seen in 46% of the group. Further study is needed to clarify the role of metformin in portal hypertension.

–  Natasha VonRoenn, MD
abstract

This abstract is available on the publisher's site.
BACKGROUND

Portal hypertension is the main determinant of clinical decompensation in patients with liver cirrhosis. In preclinical data metformin lowers portal pressure, but there are no clinical data for this beneficial effect.
AIMS

To investigate the acute effects of metformin on hepatic venous pressure gradient (HVPG) and liver perfusion.
METHODS

In a randomised, double-blinded study design, we investigated 32 patients with cirrhosis before and 90 minutes after ingestion of 1000-mg metformin (n = 16) or placebo (n = 16). Liver vein catherisation was performed to evaluate HVPG and indocyanine green (ICG) infusion for investigation of hepatic blood flow.
RESULTS

The mean relative change in HVPG was -16% (95% CI: -28% to -4%) in the metformin group compared with 4% (95% CI: -6% to 14%) in the placebo group (time × group interaction, P = 0.008). In patients with baseline HVPG ≥12 mm Hg clinically significant improvements in HVPG (HVPG <12 mm Hg or a >20% reduction in HVPG) were observed in 46% (6/13) of metformin-treated and in 8% (1/13) of placebo-treated patients (P = 0.07). There were no changes or differences in systemic blood pressure, heart rate, hepatic plasma and blood flow, hepatic ICG clearance, hepatic O2 uptake or inflammation markers between groups.
CONCLUSIONS

A single oral metformin dose acutely reduces HVPG in patients with portal hypertension without affecting systemic or liver hemodynamics or inflammatory biomarkers. This offers a promising perspective of a safe and inexpensive treatment option that should be investigated in larger-scale clinical studies with long-term outcomes in patients with cirrhosis and portal hypertension.

StephenW

https://www.practiceupdate.com/c ... S0&lid=20849513