医脉通编译，转载请注明出处。
非选择性β受体阻滞剂是唯一公认的降低门静脉压力的治疗方案。然而，其对许多病例的抗门静脉压效果不足，副作用限制了其在临床上的应用。已知Gut细菌易位和内毒素产物会增加肝硬化患者的门静脉压力。第50届欧洲肝脏研究学会（EASL）年会上公布的一项研究分析了添加非吸收性抗生素
研究方法
我们纳入了2011年1月至2013年7月间的65例晚期肝硬化患者，并随机分配普萘洛尔单药治疗（n= 48）以及普萘洛尔和利福昔明联合治疗（n= 17）。单药治疗组的普萘洛尔剂量最大为320mg/天，目标是使心率（HR）降低25％。联合用药组的普萘洛尔剂量根据心率调整，但最大剂量不超过160mg/天，利福昔明剂量为1200mg/天。对所有患者基线和治疗后3个月后的肝静脉压力梯度（HVPG）进行检测。患者HVPG下降≥20％或低于12mmHg定义为有效。同时也收集平均血压（MBP）和HR，副作用和其他血清学数据。
研究结果
两组门脉压力下降明显（普萘洛尔单药组17.0±3.9mmHg至13.5±4.1mmHg，联合组为16.7±3.6 mmHg至10.9±4.7mmHg，P <0.001）。联合治疗组的HVPG应答率表现较单一治疗组佳（82.4％：50.0％，P = 0.018），联合治疗组的HVPG平均下降值也更大（5.8±3.8mmHg：3.5±3.9mmHg，P = 0.038） ，尤其是联合治疗组的普萘洛尔的平均剂量（152±59.3mg：127.0±32.4mg，P = 0.033）以及HR的下降幅度（20.5±13.0％：7.4±15.5％，P = 0.001）较小。 两组间MBP的下降没有差异（4.4±12.3mmHg：11.7±3.1mmHg，P = 0.695）。单药治疗组8例，联合治疗组2例发现低血压相关性
结论
普萘洛尔和利福昔明联合治疗在HVPG下降方面表现出累加效应，且普萘洛尔剂量和副作用均较小，这显示，利福昔明是打破非选择性β受体阻滞剂局限性的一个很好的解决方案。
英文原文
RIFAXIMIN AND PROPRANOL OL COMBINATION THERAPY IS MORE EFFECTIVE THAN PROPRANOL OL MONOTHERAPY IN THE HEPATIC VENOUS PRESSURE GRADIENT RESPONSE AND PROPRANOL OL DOSE REDUCTION – A PILOT STUDY (Abstrat No G03)
Authors：S.K. Baik1 , Y.L. Lim1 , Y.Z. Cho1 , M.Y. Kim1 , Y.O. Jang2, K.T. Suk3, G.J. Cheon4, Y.D. Kim4, D.H. Choi5. 1 Internal Medicine, 2Cell Therapy and Tissue Engineering, Wonju Christian Hospital, Wonju, 3Internal Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, 4Internal Medicine, Kangneung Asan Hospital, Kangneung, 5Internal Medicine, Kangwon University School of Medicine, Chuncheon, Korea, South
Background and Aims: Nonselective beta blocker is the only regimen accepted to reduce the portal pressure. However its anti-portal pressure effect is insufficient in many cases and the side effects have made a limitation in clinical use. Gut bacterial translocation and production of endotoxin is known to increase portal pressure in cirrhosis. So, this study investigated the effect of addition of gut decontamination therapy using non-absorbable antibiotics, rifaximin to nonselective beta blocker, propranolol.
Methods: We included 65 patients of advanced cirrhosis from January 2011 to July 2013 and randomly assigned propranolol monotherapy (n = 48) and propranolol and rifaximin combination therapy (n = 17). For monotherapy group, propranolol dose was titrated to maximum 320 mg/day with a target of 25% heart rate (HR) reduction. In combination group, propranolol dose was also titrated according to the HR however, the maximum dose was limited to 160 mg/day and rifaximin 1200 mg/day was administered. Both baseline and treatment 3months later hepatic venous pressure gradient (HVPG) were measured in all patients. Patients with HVPG reduction by ≥20% or to less than 12 mmHg were defined as responders. Mean blood pressure (MBP) and HR, side effects and other serologic data were also collected.
Results: Portal pressure declined significantly in both groups (propranolol monotherapy group 17.0±3.9 mmHg to 13.5±4.1 mmHg, combination group 16.7±3.6 mmHg to 10.9±4.7 mmHg, each P < 0.001). Combination group showed better HVPG response rate than monotherapy group (82.4% vs. 50.0%, P = 0.018) and the mean reduction of HVPG was also larger in combination group (5.8±3.8 mmHg vs. 3.5±3.9 mmHg, P = 0.038). Especially, the mean dose of propranolol (152±59.3 mg vs. 127.0±32.4 mg, P = 0.033) and the reduction of HR (20.5±13.0% vs. 7.4±15.5%, P = 0.001) were smaller in combination group. The reduction of MBP did not show difference between two groups (4.4±12.3 mmHg vs. 3.1±11.7 mmHg, P = 0.695). Dizziness related with orthostatic hypotension was observed in 8 (mono) and 2 (combination) cases of each group.
Conclusions: Propranolol and rifaximin combination therapy showed additive effect in the reduction of HVPG with smaller dose of propranolol and side effects and it suggests that addition of rifaximin can be a good solution to break the limitations of non-selective beta blocker.
查看会议专题》》》第50届欧洲肝脏研究学会（EASL）年会
(本网站所有内容，凡注明来源为“医脉通”，版权均归医脉通所有，未经授权，任何媒体、网站或个人不得转载，否则将追究法律责任，授权转载时须注明“来源：医脉通”。本网注明来源为其他媒体的内容为转载，转载仅作观点分享，版权归原作者所有，如有侵犯版权，请及时联系我们。)
