米多德林加上普罗兰诺洛尔与单独的普罗兰诺洛尔在预防肝硬化和严重炎患者的第一次出血方面:一项随机对照试验
Abhijeet Ranjan1, Ankur Jindal1, Rakhi Maiwall1
1Department of Hepatology, Institute of Liver and Biliary Sciences, D - 1, Vasant Kunj, New Delhi, 110070, India.
Hepatology international
|May 10, 2024
概括
将midodrine添加到propranolol中显著降低了肝硬化和严重的患者中第一次水出血的发生率. 这种组合疗法还改善了的控制,并减少了并发症,相比单独使用propranolol.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 胃肠病学 胃肠病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 布罗普拉诺洛尔是一种β-阻断剂,用于预防水出血,但在严重的炎中可能导致循环问题.
- 米多德林是一种α-1激动剂,增强透和全身血动力学.
- 结合midodrine和propranolol可能允许使用更高剂量的propranolol,这可能会降低患有严重瘤的肝硬化患者的水出血风险.
研究的目的:
- 评价添加midodrine到propranolol的疗效和安全性,以预防肝硬化和严重/耐药的患者的水出血.
- 为了比较服用propranolol加midodrine和单独服用propranolol的患者在一年内发生的水出血的发生率.
主要方法:
- 一项随机试验,涉及140名肝硬化和严重/耐火性炎患者.
- 患者被分配给接受普罗兰诺洛和米多德林 (A组,n=70) 或仅接受普罗兰诺洛 (B组,n=70).
- 主要结局是1年后水出血的发生率;次要结局包括风控制,心率反应,HVPG和不良事件.
主要成果:
- 一年后水出血的累积发病率在A组 (8.5%) 与B组 (27.1%) 相比显著较低.
- 组A获得了更高的最大耐受剂量和更大降低肝静脉压梯度 (HVPG).
- A组的患者经历了更好的风控制,改善了尿剂耐受性和较少的风相关并发症.
结论:
- 将midodrine添加到propranolol中可以促进更高的有效剂量的propranolol和更大的HVPG减少.
- 这种组合疗法有效地预防了第一个水出血,并减少了患有肝硬化和严重/耐药性炎的患者的炎相关并发症.
- 补充米多丁改善了结果,包括降低了对体的要求,减少了像后体循环功能障碍这样的并发症.
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