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【medical-news】门脉高压的改良治疗
Spironolactone, a drug commonly used in cirrhotics with ascites to reduce fluid overload, has been found to have an independent portal hypotensive effect. This drug has been in use for a long period of time and has been found to be safe and free of side effects, except for occasional gynaecomastia.
This study, performed by a team lead by Professor Binay K. De, is described in a research article published in the World Journal of Gastroenterology. In the authors' view, the combination of spironolactone with propranolol scores over other combinations for variceal re-bleed, because of the different mechanisms of action of the two drugs and some of the unique properties of spironolactone.
Spironolactone has a direct portal hypotensive effect in addition to its ability to reduce plasma volume by diuresis. Spironolactone has a direct effect on the vasculature and suppressive effect on immunoactive and inflammatory cytokines, independent of its anti-aldosterone effect. An antifibrotic property has also been evidenced experimentally in rats. Because it is a long acting drug, a single daily dosage will suffice.
Using a rational study design, portal pressure was measured after hemodynamic stabilization of the patients. The drugs were administered and the effects were re-assessed on day eight. This allowed time for stabilization of drug levels in the plasma and also provided us information on the early portal hemodynamic changes following drug administration, because the maximal risk of re-bleeding is during the first two weeks.
However, further research using a larger number of patients with a long term follow up is warranted before declaring this combination to be the choice of treatment in preventing variceal re-bleeding. 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领 Bleeding from ruptured esophageal varices is the main complication of portal hypertension and a major cause of death. About one-third of variceal bleeding episodes are fatal while 70% of survivors re-bleed within a year.
食管静脉曲张破裂出血是门静脉高压的主要并发症和死亡的主要原因。大约1/3的曲张静脉出血发作是致死性的，而且70%的幸存者在1年内会再次出血。
Propranolol, the drug of choice for primary prevention of variceal bleeding, has been found to be effective in 45% of patients who have never bled, and in only 40% of patients who have had a bleeding episode before.
普萘洛尔，作为预防食道静脉曲张出血的首选药物，对于45%从未出血的地患者是有效的，而对于以前有过出血发作病史的患者有效率仅为40%。
Thus, this drug does not protect a significant number of patients and combination therapy has been advocated as a result. Various drug combinations have been tried, most commonly propranolol with isosorbide mononitrate.
因为该药不能对相当数量的患者提供保护，所以有人提出了联合用药治疗方案。不同的联合用药被尝试，最常见的就是普萘洛尔联合单硝酸异山梨酯。
However, the problem with combination therapy is an increased incidence of side effects, poor tolerability and lack of compliance. The search for an ideal drug combination that is effective, relatively free from side effects and easy to administer, has been elusive.
然而，联合用药的问题是副作用的发生率上升、低耐受性和病人依从性缺乏。寻求一种有效的、相对无副作用和易于服用的理想的联合用药依然困难重重。
Spironolactone, a drug commonly used in cirrhotics with ascites to reduce fluid overload, has been found to have an independent portal hypotensive effect. This drug has been in use for a long period of time and has been found to be safe and free of side effects, except for occasional gynaecomastia.
螺内酯（安体舒通），一种常用于降低肝硬化腹水的液体过载的药物，被发现拥有独立的降低门静脉压力的作用。该药已在临床长期应用并且安全无副作用，仅仅偶见男性乳房发育。
This study, performed by a team lead by Professor Binay K. De, is described in a research article published in the World Journal of Gastroenterology. In the authors' view, the combination of spironolactone with propranolol scores over other combinations for variceal re-bleed, because of the different mechanisms of action of the two drugs and some of the unique properties of spironolactone.
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作者:admin@医学,生命科学 2011-03-01 05:14
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