β受体阻断剂用于预防肝硬化患者出现胃食管静脉曲张

作     者：Groszmann R.J Garcia-Tsao G Bosch J. 马超 

作者机构：Yale University School of Medicine VA CT Healthcare System Digestive Disease Section/ 111H 950 Campbell AveWest Haven CT 06516 United StatesDr. 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2006年第2卷第5期

页      面：16-16页

学科分类：1007[医学-药学(可授医学、理学学位)] 1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：胃食管静脉曲张 β受体阻断剂 肝硬化患者 预防 出现 肝硬化门静脉高压 静脉曲张破裂出血 安慰剂治疗 门静脉压力 显著性差异 

摘      要：BACKGROUND: Nonselective beta-adrenergic blockers decrease portal pressure and prevent variceal hemorrhage. Their effectiveness in preventing varices is unknown. METHODS: We randomly assigned 213 patients with cirrhosis and portal hypertension(minimal hepatic venous pressure gradient[HVPG] of 6 mm Hg) to receive timolol, a nonselective beta-blocker(108 patients), or placebo(105 patients). The primary end point was the development of gastroesophageal varices or variceal hemorrhage. Endoscopy and HVPG measurements were repeated yearly. RESULTS: During a median follow-up of 54.9 months, the rate of the primary end point did not differ significantly between the timolol group and the placebo group(39 percent and 40 percent, respectively; P=0.89), nor were there significant differences in the rates of ascites, encephalopathy, liver transplantation, or death. Serious adverse events were more common among patients in the timolol group than among those in the placebo group(18 percent vs. 6 percent, P=0.006). Varices developed less frequently among patients with a baseline HVPG of less than 10 mm Hg and among those in whom the HVPG decreased by more than 10 percent at one year and more frequently among those in whom the HVPG increased by more than 10 percent at one year. CONCLUSIONS: Nonselective beta-blockers are ineffective in preventing varices in unselected patients with cirrhosis and portal hypertension and are associated with an increased number of adverse events.(*** number, NCT00006398.)