非选择性β受体阻滞剂对门脉高压性胃病治疗效果的临床观察

发布时间：2018-05-27 12:17

本文选题：门脉高压性胃病 + 治疗　；参考：《山东大学》2014年硕士论文

【摘要】：研究背景与目的随着内窥镜的发展及其在临床的广泛应用,门脉高压性胃病(Portal Hypertensive Gastropathy, PHG)引起越来越多的关注。虽然到目前为止就其发病机制仍未达成共识,但国内外研究普遍认为门静脉压力的升高是门脉高压性胃病存在的重要条件。而非选择性p受体阻滞剂(Nonselective beta blocker, NSBB)普萘洛尔是临床上用于降低门静脉压力的首选药物,同时也是推荐用于门脉高压性胃病出血治疗的首选药物；但有关普萘洛尔在门脉高压性胃病治疗中的临床研究仍很少。而新型非选择性p受体阻断剂——卡维地洛同样具有较强的非选择性p受体阻滞作用,同时具有一定的拮抗α1受体的作用,其在门脉高压的治疗作用可能优于普萘洛尔,但目前关于卡维地洛在门脉高压性胃病治疗中的研究资料十分缺乏。同时普萘洛尔与卡维地洛对门脉高压性胃病的疗效的对比研究资料十分稀少,对于两者在门脉高压性胃病的治疗中是否存在差异仍缺乏足够的研究支持。本研究主要为了探究门脉高压性胃病与门静脉压力之间所存在的关系；同时研究非选择性p受体阻滞剂——普萘洛尔及卡维地洛在门脉高压性胃病治疗中的作用及其两者间疗效的比较。研究方法本研究收集山东大学附属山东省立医院东院内镜中心2010年4月-2014年3月所有经胃镜检查证实门脉高压性胃病、既往无消化道出血病史、并住院行肝静脉压力梯度测定(Hepatic Venous Pressure Gradient, HVPG)检测的患者为研究对象。符合条件的所有患者分为3组：A组为未服用非选择性β受体阻断剂的患者,B组为服用普萘洛尔的患者,C组为服用卡维地洛的患者。并对入组患者进行详细的记录,包括：年龄、性别、肝静脉压力梯度(HVPG).肝功、肾功能及门脉高压性胃病Baveno[3]评分[4]分值。对比各组患者门脉高压性胃病Baveno分值前后变化,并且分析各组内使用药物前后门脉高压性胃病严重程度的差异。初始门脉高压性胃病为PHG1,3月后门脉高压性胃病分值为PHG2,用药前后分值变化PHG3=PHG2-PHG1;同时对比用药组与对照组间的PHG3差异,分析门脉高压性胃病与用药的关系；具体设计流程图(见附图1)。结果运用SPSS v20.0中文版软件包对所统计数据进行分析。结果本研究资料齐全患者60例,A组19例,初始门脉高压性胃病Baveno分值PHG1=1.74±1.10,3月后复查时门脉高压性胃病Baveno分值PHG2=3.16±0.90; P=0.26, P0.05,无统计学意义；B组14例,初始门脉高压性胃病Baveno分值PHG1=3.36±1.65,3月后复查时门脉高压性胃病Baveno分值PHG2=2.57±1.45:P=0.02, P0.05,有统计学意义。C组27例,初始门脉高压性胃病Baveno分值PHG1=2.56±1.34,3月后复查时门脉高压性胃病Baveno分值PHG2=1.63±1.71; P=0.00, P0.05,有统计学意义。A组PHG3=1.42±1.22,B组PHG3=-0.79±1.37,C组PHG3=-0.93±1.30;A组和B组比较：P=0.00,P0.05,有统计学意义；A组和C组比较：P=0.00,P0.05,有统计学意义；B组合C组比较,P=0.94,P0.05,无统计学意义。结论 1.门静脉压力增高是门脉高压性胃病的重要条件,但并非唯一条件；同时门静脉压力的高低与门脉高压性胃病的严重程度不存在线性关系。 2.非选择β受体阻滞剂——普萘洛尔及卡维地洛均能显著降低门脉高压性胃病的严重程度。 3.普萘洛尔及卡维地洛在降低门脉高压性胃病的严重程度方面无显著差异。
[Abstract]:Research background and purpose
With the development of endoscopy and its wide application in clinical practice, Portal Hypertensive Gastropathy (PHG) has attracted more and more attention. Although no consensus has been reached on its pathogenesis so far, it is generally believed that the increase of portal pressure is an important condition for the existence of portal hypertensive gastropathy. The non selective P receptor blocker (Nonselective beta blocker, NSBB) propranolol is the first drug used to reduce portal pressure and is also recommended for the treatment of portal hypertensive gastropathy. However, there are few clinical studies on propranolol in the treatment of portal hypertensive gastropathy. The Selective P receptor blocker, carvedilol, also has a strong non selective P receptor blocking effect and has a certain antagonistic effect on the alpha 1 receptor. The therapeutic effect of carvedilol on the portal hypertension may be better than propranolol, but the current research on carvedilol in the treatment of portal hypertensive gastropathy is very short. The comparative study of the curative effect of carvedilol and carvedilol on portal hypertensive gastropathy is very rare. There is still a lack of sufficient research support for the difference between the two in the treatment of portal hypertensive gastropathy. This study is mainly to explore the relationship between portal hypertension and portal vein pressure. The role of Selective P receptor blocker propranolol and carvedilol in the treatment of portal hypertensive gastropathy and the comparison between them.
research method
This study collected all the patients in the endoscopy center of the Eastern Hospital of Shandong University, Shandong University, in March -2014 April 2010. All patients who had been examined by gastroscopy proved portal hypertensive gastropathy, had no history of hemorrhage in the digestive tract, and were detected by Hepatic Venous Pressure Gradient, HVPG in hospitalized patients. All patients were divided into 3 groups: the A group was a patient who did not take the non selective beta blocker, the B group was taken propranolol, the C group was taken carvedilol, and the patients in the group were recorded in detail, including age, sex, liver vein pressure gradient (HVPG), liver function, renal function, and portal hypertensive gastropathy, Baveno[3] score [4] The changes in the Baveno score of the portal hypertensive gastropathy in each group were compared, and the difference in the severity of portal hypertensive gastropathy was analyzed before and after the use of drugs. The value of the initial portal hypertensive gastropathy was PHG2 after PHG1,3 months, and the score of PHG3=PHG2-PHG1 before and after the drug use was changed; at the same time, the drug group and the control were compared. The PHG3 difference between groups was used to analyze the relationship between portal hypertensive gastropathy and drug use; specific design flow chart (see Figure 1). Results the statistical data were analyzed with the Chinese version of SPSS v20.0 software package.
Result
There were 60 patients with complete data in this study and 19 cases in group A. The value of Baveno of initial portal hypertensive gastropathy was PHG1=1.74 + 1.10,3 months after PHG1=1.74 + 1.10,3 months. The value of Baveno of portal hypertensive gastropathy was PHG2=3.16 + 0.90; P=0.26, P0.05, no statistical significance; 14 cases in group B, Baveno of initial portal hypertensive gastropathy in PHG1=3.36 + 1.65,3 month review The score of Baveno was PHG2=2.57 + 1.45:P=0.02 and P0.05. There were 27 cases in group.C with statistical significance. The Baveno score of initial portal hypertensive gastropathy was PHG1=2.56 + 1.34,3 months after PHG1=2.56 + 1.34,3 months. The Baveno score of portal hypertensive gastropathy was PHG2=1.63 + 1.71; P=0.00, P0.05. Group comparison: P=0.00, P0.05, there was statistical significance; A group and C group: P=0.00, P0.05, there was statistical significance; B combination C group comparison, P=0.94, P0.05, no statistical significance.
conclusion
The increased pressure of 1. portal veins is an important condition for portal hypertensive gastropathy, but it is not the only condition. There is no linear relationship between the pressure of portal vein and the severity of portal hypertensive gastropathy.
2. no choice of beta blockers propranolol and carvedilol can significantly reduce the severity of portal hypertensive gastropathy.
3. there was no significant difference in the severity of portal hypertensive gastropathy between propranolol and carvedilol.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R573.9

【参考文献】