目的:比较卡维地洛与普萘洛尔降低肝硬化门静脉高压患者肝静脉压力梯度(hepatic venous pressure gradient,HVPG)的近期疗效.方法:按照随机数字表法将海南省琼海市人民医院收治的96例肝硬化门静脉高压患者均分为实验组和对照组,实验组...目的:比较卡维地洛与普萘洛尔降低肝硬化门静脉高压患者肝静脉压力梯度(hepatic venous pressure gradient,HVPG)的近期疗效.方法:按照随机数字表法将海南省琼海市人民医院收治的96例肝硬化门静脉高压患者均分为实验组和对照组,实验组患者给予卡维地洛治疗,对照组患者给予普萘洛尔治疗,比较两组患者治疗前后血流动力学指标:肝静脉楔入压(wedged hepatic venous pressure,WHVP)、肝静脉游离压(free hepatic venous p r e s s u r e,F H V P)、H V P G、平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR);肝肾功能指标:丙氨酸氨基转氨酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转氨酶(aspartate aminotransferase,AST)、总胆红素(total bilirubin,TBIL)、血清肌酐(serum creatinine,SCr)、血尿素氮(blood urea nitrogen,BUN)变化情况以及不良反应发生情况.结果:实验组患者治疗后WHVP、HVPG、MAP、HR水平均显著下降(16.26 mmHg±5.28 mmHg vs 18.42 mmHg±6.83 mmHg,10.01 mmHg±3.77 mmHg vs 13.42 mmHg±5.68 mmHg,85.58 mmHg±10.42 mmHg vs95.16 mmHg±12.03 mmHg,62.99次/min±5.24次/min vs 75.39次/min±7.78次/min,与治疗前比较,差异具有统计学意义(P<0.05);对照组患者治疗后HVPG、MAP、HR水平均显著下降(12.03 mmHg±4.63 mmHg vs13.54 mmHg±5.78 mmHg,89.52 mmHg±12.55 mmHg vs 95.29 mmHg±13.25 mmHg,61.08次/min±7.66次/min vs 73.98次/min±6.46次/min),与治疗前比较,差异具有统计学意义(P<0.05);实验组患者HVPG应答者27例,应答率为56.25%,对照组患者HVPG应答者20例,应答率为41.67%,两组患者应答率比较(56.25%vs 41.67%),差异无统计学意义(P>0.05);实验组患者治疗后HVPG和MAP下降幅度均显著高于对照组(28.30%±22.19%vs 12.38%±24.09%,10.67%±6.77%vs 6.06%±5.79%),差异具有统计学意义(P<0.05);对照组患者治疗后SCr水平显著下降(70.82 mg/d±11.60 mg/d vs 76.57mg/d±15.22 mg/d),与治疗前比较,差异具有统计学意义(P<0.05);实验组患者肝肾功能各项指标均未发现明显变化(36.79 IU/L±19.62 IU/L vs 48.84 IU/L±31.66 IU/L,44.55IU/L±21.41 IU/L vs 46.42 IU/L±24.81 IU/L,26.56μmol/L±16.43μmol/L vs 25.94μmol/L±18.30μmol/L,74.97 mg/d±15.33 mg/d vs75.71 mg/d±12.33 mg/d,5.02 mg/d±2.47mg/d vs 5.26 mg/d±1.69 mg/d),与治疗前比较,差异无统计学意义(P>0.05);两组患者均未发生明显不良反应,治疗前伴腹水者用药期间未见腹水加重,治疗前不伴腹水者用药期间未见有腹水形成趋势.结论:卡维地洛与普萘洛尔均可有效降低肝硬化门静脉高压患者HVPG,降低食管胃静脉曲张出血的发生风险,且两药均对肝肾功能无明显影响、无用药不良反应,其中卡维地洛疗效更佳.展开更多
目的研究探讨肝静脉压力梯度（HVPG）预测内镜下食管静脉曲张套扎术（EVL）后2周内再出血的预测效果。方法采用前瞻性研究设计,观察有肝硬化食管静脉曲张出血史的患者112例,入院48 h内检测HVPG。采用多元Logistic回归及受试者工作特征...目的研究探讨肝静脉压力梯度（HVPG）预测内镜下食管静脉曲张套扎术（EVL）后2周内再出血的预测效果。方法采用前瞻性研究设计,观察有肝硬化食管静脉曲张出血史的患者112例,入院48 h内检测HVPG。采用多元Logistic回归及受试者工作特征曲线（ROC）法进行分析。结果 Logistic回归结果显示：HVPG和Child-Pugh分级是EVL术后早期再出血的独立危险因素;HVPG预测EVL术后早期再出血的ROC曲线下的面积为：0.823（0.745~0.901）（P〈0.05）,并且当HVPG=16.46 mm Hg时,灵敏度和特异度均最高,分别为：85.45%和69.12%。结论 HVPG可以作为预测EVL术后2周内是否发生再出血的独立危险因素,具有较高的预测价值;当HVPG=16.46 mm Hg其预测价值达到高峰,灵敏度为85.45%,特异度为69.12%。展开更多
Background and Aims:Studies have indicated that serum von Willebrand factor(vWF)has a positive correlation with hepatic venous pressure gradient.However,information on the value of vWF in the diagnosis of liver cirrho...Background and Aims:Studies have indicated that serum von Willebrand factor(vWF)has a positive correlation with hepatic venous pressure gradient.However,information on the value of vWF in the diagnosis of liver cirrhosis with portal hypertension has been lacking.The purpose of this meta-analysis was to assess the value of vWF in the diagnosis of liver cirrhosis with portal hypertension.Methods:Studies that analyzed the sensitivity,specificity,diagnostic odds ratio combined with likelihood ratios and test for heterogeneity of vWF in the diagnosis of liver cirrhosis with portal hypertension were found in the Cochrane Library,Ovid,VOS-SCI,CNKI,PubMed,Medline,EMBASE,CMB and Wanfang databases.In the end,the data was used to draw the summary receiver operating characteristic curve and to calculate the area under the curve.Results:Four studies involving 662 patients were analyzed.The results showed that serum vWF in liver cirrhosis with portal hypertension were significantly higher than in those without portal hypertension.Sensitivity combined was 0.823(95%CI:0.788,0.855).Specificity combined was 0.782(95%CI:0.708,0.845).+LR combined was 3.777(95%CI:2.794,5.107).-LR combined was 0.221(95%CI:0.180,0.272).Diagnostic odds ratio combined was 18.347(95%CI:11.725,28.708).The area under the curve was 0.8896.Conclusions:Serum vWF can be used as an effective and feasible method for noninvasive diagnosis of liver cirrhosis with portal hypertension.However,further studies are still needed to evaluate the severity of liver cirrhosis with portal hypertension.展开更多
文摘目的:比较卡维地洛与普萘洛尔降低肝硬化门静脉高压患者肝静脉压力梯度(hepatic venous pressure gradient,HVPG)的近期疗效.方法:按照随机数字表法将海南省琼海市人民医院收治的96例肝硬化门静脉高压患者均分为实验组和对照组,实验组患者给予卡维地洛治疗,对照组患者给予普萘洛尔治疗,比较两组患者治疗前后血流动力学指标:肝静脉楔入压(wedged hepatic venous pressure,WHVP)、肝静脉游离压(free hepatic venous p r e s s u r e,F H V P)、H V P G、平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR);肝肾功能指标:丙氨酸氨基转氨酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转氨酶(aspartate aminotransferase,AST)、总胆红素(total bilirubin,TBIL)、血清肌酐(serum creatinine,SCr)、血尿素氮(blood urea nitrogen,BUN)变化情况以及不良反应发生情况.结果:实验组患者治疗后WHVP、HVPG、MAP、HR水平均显著下降(16.26 mmHg±5.28 mmHg vs 18.42 mmHg±6.83 mmHg,10.01 mmHg±3.77 mmHg vs 13.42 mmHg±5.68 mmHg,85.58 mmHg±10.42 mmHg vs95.16 mmHg±12.03 mmHg,62.99次/min±5.24次/min vs 75.39次/min±7.78次/min,与治疗前比较,差异具有统计学意义(P<0.05);对照组患者治疗后HVPG、MAP、HR水平均显著下降(12.03 mmHg±4.63 mmHg vs13.54 mmHg±5.78 mmHg,89.52 mmHg±12.55 mmHg vs 95.29 mmHg±13.25 mmHg,61.08次/min±7.66次/min vs 73.98次/min±6.46次/min),与治疗前比较,差异具有统计学意义(P<0.05);实验组患者HVPG应答者27例,应答率为56.25%,对照组患者HVPG应答者20例,应答率为41.67%,两组患者应答率比较(56.25%vs 41.67%),差异无统计学意义(P>0.05);实验组患者治疗后HVPG和MAP下降幅度均显著高于对照组(28.30%±22.19%vs 12.38%±24.09%,10.67%±6.77%vs 6.06%±5.79%),差异具有统计学意义(P<0.05);对照组患者治疗后SCr水平显著下降(70.82 mg/d±11.60 mg/d vs 76.57mg/d±15.22 mg/d),与治疗前比较,差异具有统计学意义(P<0.05);实验组患者肝肾功能各项指标均未发现明显变化(36.79 IU/L±19.62 IU/L vs 48.84 IU/L±31.66 IU/L,44.55IU/L±21.41 IU/L vs 46.42 IU/L±24.81 IU/L,26.56μmol/L±16.43μmol/L vs 25.94μmol/L±18.30μmol/L,74.97 mg/d±15.33 mg/d vs75.71 mg/d±12.33 mg/d,5.02 mg/d±2.47mg/d vs 5.26 mg/d±1.69 mg/d),与治疗前比较,差异无统计学意义(P>0.05);两组患者均未发生明显不良反应,治疗前伴腹水者用药期间未见腹水加重,治疗前不伴腹水者用药期间未见有腹水形成趋势.结论:卡维地洛与普萘洛尔均可有效降低肝硬化门静脉高压患者HVPG,降低食管胃静脉曲张出血的发生风险,且两药均对肝肾功能无明显影响、无用药不良反应,其中卡维地洛疗效更佳.
文摘目的研究探讨肝静脉压力梯度（HVPG）预测内镜下食管静脉曲张套扎术（EVL）后2周内再出血的预测效果。方法采用前瞻性研究设计,观察有肝硬化食管静脉曲张出血史的患者112例,入院48 h内检测HVPG。采用多元Logistic回归及受试者工作特征曲线（ROC）法进行分析。结果 Logistic回归结果显示：HVPG和Child-Pugh分级是EVL术后早期再出血的独立危险因素;HVPG预测EVL术后早期再出血的ROC曲线下的面积为：0.823（0.745~0.901）（P〈0.05）,并且当HVPG=16.46 mm Hg时,灵敏度和特异度均最高,分别为：85.45%和69.12%。结论 HVPG可以作为预测EVL术后2周内是否发生再出血的独立危险因素,具有较高的预测价值;当HVPG=16.46 mm Hg其预测价值达到高峰,灵敏度为85.45%,特异度为69.12%。
基金This study was supported by the National Natural Science Foundation of China(No.81760363)the National Key R&D Program of China(No.2016YFD0400605)the Natural Science Foundation of Ningxia(NZ16156,2018AAC02014)
文摘Background and Aims:Studies have indicated that serum von Willebrand factor(vWF)has a positive correlation with hepatic venous pressure gradient.However,information on the value of vWF in the diagnosis of liver cirrhosis with portal hypertension has been lacking.The purpose of this meta-analysis was to assess the value of vWF in the diagnosis of liver cirrhosis with portal hypertension.Methods:Studies that analyzed the sensitivity,specificity,diagnostic odds ratio combined with likelihood ratios and test for heterogeneity of vWF in the diagnosis of liver cirrhosis with portal hypertension were found in the Cochrane Library,Ovid,VOS-SCI,CNKI,PubMed,Medline,EMBASE,CMB and Wanfang databases.In the end,the data was used to draw the summary receiver operating characteristic curve and to calculate the area under the curve.Results:Four studies involving 662 patients were analyzed.The results showed that serum vWF in liver cirrhosis with portal hypertension were significantly higher than in those without portal hypertension.Sensitivity combined was 0.823(95%CI:0.788,0.855).Specificity combined was 0.782(95%CI:0.708,0.845).+LR combined was 3.777(95%CI:2.794,5.107).-LR combined was 0.221(95%CI:0.180,0.272).Diagnostic odds ratio combined was 18.347(95%CI:11.725,28.708).The area under the curve was 0.8896.Conclusions:Serum vWF can be used as an effective and feasible method for noninvasive diagnosis of liver cirrhosis with portal hypertension.However,further studies are still needed to evaluate the severity of liver cirrhosis with portal hypertension.
文摘目的研究卡维地洛和普萘洛尔降低肝硬化门静脉高压患者肝静脉压力梯度(HVPG)疗效之间的差异。方法利用网络对Pub Med、Cochrane Library、维普、万方数据库进行搜索,纳入对比卡维地洛和普萘洛尔降低肝静脉压力疗效的临床研究。研究的质量利用Cochrane偏倚风险评价表进行评价。利用Rev Man 5.2软件对研究数据进行meta分析,计算比值比(OR)和均差(MD),同时进行I2检验评价meta分析的异质性。结果卡维地洛组比普萘洛尔组拥有更高的HVPG下降率(P<0.05)和平均动脉压(MAP)下降率(P<0.05),更低的治疗后肝静脉楔压(WHVP)水平(P<0.05),以及更少的HVPG无应答人数(P<0.05)。而MAP下降率和治疗后WHVP水平的meta分析结果有较大的异质性。结论卡维地洛降低HPVG的疗效优于普萘洛尔,而卡维地洛在降低MAP和WHVP方面的疗效是否优于普萘洛尔还有待进一步研究。
