の再出血の予防について
Jaume Bosch1, Juan Carlos García-Pagán
1Hepatic Haemodynamic Laboratory, Liver Unit, Institut de Malalties Digestives, Hospital Clínic, IDIBAPS, University of Barcelona, 08036, Barcelona, Spain. jbosch@medicina.ub.es
Lancet (London, England)
|March 22, 2003
まとめ
肝硬変患者における性再出血の予防は,ポータル圧縮が不十分である患者では,ベータブロッカーにイソソルビド-5-モノニートレート (ISMN) を加えることで改善することができます. この標的型薬物療法により,高リスクの個人に効果が向上します.
科学分野:
- ヘパトロジーと胃腸内科
- 臨床試験と治療法について
背景:
- の出血は,肝硬変患者のポータル高血圧の重篤な合併症であり,高度の再出血率と死亡率につながる.
- 現在の予防戦略には,内視帯束縛 (EBL),TIPS,ベータブロッカーによる薬物療法などがありますが,それぞれに限界があります.
- 特定の薬物療法の恩恵を受ける患者を特定することは,効果的な再出血予防に不可欠です.
研究 の 目的:
- 肝硬変およびポータル高血圧の患者におけるベータブロッカー療法にイソソルビド-5モノニートレート (ISMN) を加える有効性を評価する.
- 肝静脈圧力梯度 (HVPG) のモニタリングが,水の再出血を予防するための治療調整を導くことができるかどうかを判断する.
- エンドスコピック・バンド・リガーション (EBL) との最適化薬物療法の有効性を比較する.
主な方法:
- 血出血の生存者におけるEBLと薬物療法 (プロプラノロール+/-ISMN) を比較したランダム化比較試験.
- 薬剤療法への反応としてポータル圧力低下を評価するために,肝静脈圧力梯度 (HVPG) の測定.
- 目標のHVPGの減少を達成できない患者のベータブロッカーにISMNを加える.
主要な成果:
- 薬物療法はEBLと同様の全体的な再出血率を示しました (1年後に54%対54%).
- ベータブロッカーにISMNを追加することで,非応答者におけるHVPGの減少が改善され,再出血率 (10%対64%) が著しく低下しました.
- 治療グループ間で生存率や非出血性合併症の有意な差は認められなかった.
結論:
- 長期の薬物療法,特にHVPGのモニタリングによって指導され,ISMNで調整された場合,水の再出血を予防するための効果的な戦略です.
- HVPGのモニタリングは,強化された薬物療法を必要とする患者を特定するために不可欠です.
- 現在の薬物療法に反応しない患者に対する最適な治療法を確立するために,さらなる試験が必要である.
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