非选择性乙型受体阻滞剂在肝硬化中的作用:“治疗窗口期”和患者生存期的影响

V. L. Korobka, V. Pasechnikov, R. V. Korobka, A. Shapovalov
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引用次数: 0

摘要

该研究的目的:分析肝移植等待名单(WLLT)中接受和未接受各种非选择性β受体阻滞剂(NSBB)类药物的患者在等待肝移植(LT)期间的生存率,这取决于是否存在预约NSBB的“治疗窗口”;在难治性腹水(RA)患者开NSBB类的各种代表时,确定死亡的危险因素。材料和方法。采用回顾性病例对照研究。“病例”组包括278例成年WLLT中各种病因失代偿性肝病患者,在等待lt期间接受NSBB治疗。“对照组”组包括72例WLLT中各种病因失代偿性肝病患者,在等待lt期间未接受NSBB治疗。在随后的分析中,接受NSBB治疗的患者组(n = 278)分为两个亚组:有“治疗窗口”(n = 175)和没有“治疗窗口”(n = 103)。采用Kaplan - Mayer法测定患者生存率。在RA (n = 103)组和非RA (n = 175)组中,使用Cox比例风险模型确定在没有NSBB“治疗窗口”的情况下接受NSBB的患者死亡率的预测因子。结果。有NSBB“治疗窗口”的NSBB患者的生存率显著高于无NSBB“治疗窗口”的WLLP患者等待LT时接受NSBB的患者组(Log-Rank < 0.0001)。NSBB治疗的RA患者死亡风险显著高于非RA患者(HR = 2.285;Ci 1.237 4.220;P = 0.008)。心得安与卡维地洛的死亡风险差异有统计学意义(HR = 2152, HR = 0.765;P = 0.042)。结论。本研究结果证实了NSBB在给失代偿性肝硬化患者开处方并纳入WLLP时存在“治疗窗口期”的假设。在出现“封闭治疗窗口期”的情况下,无论何种药物,NSBB的使用都会增加RA患者的死亡率。为了降低因急性器官缺陷而等待肝移植数年的患者死亡率,引导患者行肝移植的医生应评估使用NSBB的风险和获益
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Non-Selective Beta-Blockers in Liver Cirrhosis: the Effect of the "Therapeutic Window" and Patient Survival
Objectives of the study: to analyze the survival rate of patients who received and did not receive various drugs of the class of non-selective beta-blockers (NSBB) while waiting for liver transplantation (LT) on the waiting list for liver transplantation (WLLT), depending on the presence or absence of a "therapeutic window" for the appointment of NSBB; to determine risk factors for death when prescribing various representatives of the NSBB class in patients with refractory ascites (RA). Material and methods. The retrospective case-control study was conducted. The "case" group included 278 adult patients with decompensated liver diseases of various etiologies included in the WLLT, who were treated with NSBB while waiting for LT. The "control" group consisted of 72 patients with decompensated liver diseases of various etiologies included in the WLLT, who did not receive NSBB therapy during the waiting period for LT. For the subsequent analysis, the group of patients receiving NSBB (n = 278) was divided into two subgroups: with the presence of a "therapeutic window" (n = 175), and without it (n = 103). The survival rate of patients was determined by the Kaplan - Mayer method. Predictors of mortality of patients receiving NSBB in the absence of a" therapeutic window "for NSBB were determined using the Cox proportional hazards model in the groups of patients with RA (n = 103) and non-RA (n = 175). Results. The survival rate of patients receiving NSBB in the presence of a" therapeutic window "for NSBB is significantly higher than in the group of patients receiving NSBB in WLLP while waiting for LT in the absence of a" therapeutic window " for NSBB (Log-Rank < 0.0001). The risk of death in patients with RA treated with NSBB was significantly higher than in patients with non-RA (HR = 2.285; CI 1.237 4.220; p = 0.008). The risk of death for patients treated with propranol was significantly different from carvedilol (HR = 2,152 and HR = 0.765; p = 0.042, respectively). Conclusion. The results of the study confirmed the hypothesis that there is a "therapeutic window" for NSBB when they are prescribed to patients with decompensated cirrhosis of the liver and included in the WLLP. The use of NSBB contributes to an increase in the mortality of patients with RA, regardless of the type of drug, in the case when the "closed therapeutic window" phase develops. In order to reduce the mortality of patients waiting for LT for several years due to acute organ deficiency, doctors who lead patients to WLLT should assess the risk and benefit of using NSBB
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