在晚期慢性肝病和急性至慢性肝衰竭中,midodrine对HVPG的影响-A试点研究
Chitranshu Vashishtha1, Ankit Bhardwaj2, Ankur Jindal1
1Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
概括
在不能服用非选择性β抑制剂的肝硬化或急性至慢性肝衰竭患者中,米多德林有效降低肝静脉压梯度 (HVPG). 为获得最佳反应,建议对 midodrine 进行定位,以使平均动脉压 (MAP) 至少增加 8.5 mmHg.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 药理学 药理学是指药理学的学科.
- 关键护理医学 关键护理医学
背景情况:
- 非选择性β抑制剂 (NSBB) 是门高血压 (PH) 的标准药物,但在不补偿性肝硬化 (DC) 或急性至慢性肝衰竭 (ACLF) 与血液动力学不稳定性方面存在风险.
- 米多德林是一种α-1上腺激素激动剂,由于其快速作用和口服,它提供了一个潜在的替代方案.
研究的目的:
- 评估米多德林对肝静脉压梯度 (HVPG) 的急性影响,在有NSBB的禁忌的DC和ACLF患者中.
- 在这个患者群体中确定对中素反应的预测因子.
主要方法:
- 一项涉及60名患者的研究 (30名DC患者,30名ACLF患者) 呈现NSBB的特定禁忌 (例如低血压,低血,AKI,HRS).
- 在基线和10mg米多德林剂后3小时内进行了HVPG测量.
- 主要结局是HVPG减少>20%或<12 mmHg.
主要成果:
- 在DC和ACLF组中,米多德林显著降低了HVPG和心率,同时增加了DC和ACLF组的平均动脉压 (MAP) (p <0.01对所有人).
- 在DC组的10%,ACLF组的26.7%观察到HVPG反应.
- 响应的独立预测因素包括先性AKI和MAP的增加 (p < 0.01). MAP的8.5 mmHg增加显示出对反应的最佳预测值.
结论:
- 在DC和ACLF患者中降低HVPG的可行选择是Midodrine,这些患者有NSBB的禁忌.
- 建议对米多德林剂量进行定位,以达到MAP至少8.5mmHg的增加,以获得最佳的治疗效果.
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