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J Hepatol:生存率不降反升 卡维地洛对失代偿性肝硬化和腹水患者无害

2017-07-27 顾歆纯 环球医学资讯

2017年7月,发表在《J Hepatol》的一项由英国科学家进行的研究表明,失代偿性肝硬化和腹水患者使用卡维地洛是安全的,并且提高了轻度腹水患者的生存率。

2017年7月,发表在《J Hepatol》的一项由英国科学家进行的研究表明,失代偿性肝硬化和腹水患者使用卡维地洛是安全的,并且提高了轻度腹水患者的生存率。

背景和目的:卡维地洛,一种具有附加抗α-1受体活性的非选择性β-阻滞剂(NSBB),是抗门脉高压的强效药物并已用于预防静脉曲张出血。然而,其对失代偿性肝硬化和腹水患者的安全性仍然存在争议。本项研究中,研究者考察了腹水患者长期使用卡维地洛是否是死亡的风险因素。
方法:对2009年1月1日~2012年8月31日肝病中心325名肝硬化和腹水的连续患者进行单中心、回顾性分析。首要结局是接受或不接受卡维地洛治疗作为静脉曲张出血预防的患者中全因和肝特异性死亡率。

结果:倾向评分匹配后的最终队列包括264名患者。在卡维地洛组(n=132人)和非卡维地洛组(n=132人)之间基线腹水严重程度和英国晚期肝病(UKELD)评分相当。中位随访时间为2.3年。随访结束时,卡维地洛组和非卡维地洛组的生存率分别为24%和2%(log-rank P<0.0001)。卡维地洛组的长期生存率显着高于非卡维地洛组(log-rank P<0.001)。调整了年龄、性别、腹水严重程度、肝硬化病因、既往静脉曲张出血、自发细菌性腹膜炎的预防、血清白蛋白和UKELD后,生存率差异依然显着,风险比为0.59(95%置信区间[CI]:0.44,0.80;P=0.001),表明死亡风险降低41%。当对腹水的严重程度分层时,对轻度腹水患者使用卡维地洛治疗的风险比是0.47(95% CI:0.29,0.77;P=0.003)。甚至在中度或重度腹水患者中,卡维地洛的使用也与死亡风险增加不相关。

结论:长期卡维地洛治疗对失代偿性肝硬化和腹水患者无害。

总结:卡维地洛和其他非选择性β阻滞剂药物在肝硬化和腹水患者中的安全性仍存在争议。在本研究中,研究者已经发现,在这些患者中,卡维地洛治疗与死亡风险降低相关,特别轻度腹水患者。研究结论是卡维地洛低剂量、慢性治疗肝硬化和腹水的患者是无害的。

专家点评:虽然该研究结果提示卡维地洛能够降低肝硬化和腹水患者死亡率,但是这种用法属于超说明书用药,仍需要进一步研究。

原始出处
Sinha R, Lockman KA, Mallawaarachchi N, et al.Carvedilol use is associated with improved survival in patients with liver cirrhosis and ascites.J Hepatol. 2017 Jul;67(1):40-46. doi: 10.1016/j.jhep.2017.02.005. Epub 2017 Feb 16.

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    2017-12-10 1581f80970m

    谢谢分享.学习了

    0

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    2017-07-29 139****9672

    学习了,不错啊

    0

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    2017-07-29 gwc384
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