The Effect Of Hepatic Functional Reserve On Non-selective Beta Blocker (NSBB) Reducing Hepatic Venous Pressure Gradient (HVPG)

Background and Objective:Cirrhosis is a serious and irreversible chronic liver lesions. The hepatic dysfunction and portal hypertension as its complications, which have high mortality rate. Child-Pugh’s Score is regularly used to evaluate the hepatic function reserve clinically. Hepatic venous pressure gradient (HVPG) is the gold standard to diagnosis portal hypertension and assess the complications of portal hypertension. The non-selective beta blocker (NSBB) is recommended clinically in reducing the portal pressure and preventing the variceal bleeding in clinical, however only1/3-1/2patients response well to it. Hepatic venous pressure gradient is also the gold standard for evaluating he efficacy of the NSBB. Some researchers have reported the effect of different hepatic function reserve of alcoholic cirrhosis on non-selective beta blocker renducing hepatic venous pressure gradient in Western. This study researched the patients of liver cirrhosis who were with esophageal, discussed the the effect of hepatic functional reserve on non-selective beta blocker reducing hepatic venous pressure gradient, comparied the different between propranolol and carvedilol.Methods:138patients of liver cirrhosis with chronic hepatitis B were randomly divided into two groups, one group taking propranolol (n=33, starting dose of10mg, tid), another group taking carvedilol (n=31, starting dose is12.5mg, qd). The HVPG was measured before all the patients taking their drugs.All the patients were monitored of blood pressure and heart rate everyday. And then the dosage was adjusted according to the changes of blood pressure and heart rate, promising the heart rate decreased to20%～25%of the baseline but not less than55beats/min, and . the blood pressure-not less than90/60mmHg.HV-PG-and-the-index-of-renal function of patients were all measured at the baseline before the drugs were administered orally, and again7days after carvedilol or propranolol administered, respectively."Responders" were defined as those with HVPG reduction at least20%from baseline or lowering HVPG to below12mmHg. The comparion of "responsers" and "non-responsers" was shown if there were any significant in the ascites, albumin(ALB), total bilirbin(TBIL), prothrombin time(PT), and hepatic encephalopathy. To discussed the the effect of hepatic functional reserve on non-selective beta blocker reducing hepatic venous pressure gradient, and compare the different between propranolol and carvedilol.Results:In this trial, there wer138case of liver cirrhosis,77patient as the "responser" group, and61patients as the "non-responser" group. The response rate of138patients was55.80%, the comparion of "responsers" and "non-responsers" was shown that there were significant in the albumin(ALB), total bilirbin(TBIL), prothrombin time(PT),(P=0.000、0.036、0.000). And there were not any significant in ascites and hepatic encephalopathy (P=0.076,0.093). There were61petients whowere taking propranolol, and only29patients as the "responser" group, the response rate of propranolol group was47.54%, the comparion of "responsers" and "non-responsers" was shown that there were significant in the albumin(ALB), total bilirbin(TBIL), prothrombin time(PT),(P=0.001、0.001、0.003). And there were not any significant in ascites and hepatic encephalopathy (P=0.067%0.119). There were77petients whowere taking carvedilol, and48patients as the "responser" group, the response rate of carvedilol group was62.34%, the comparion of "responsers" and "non-responsers" was shown that there were significant in the albumin(ALB), total bilirbin(TBIL), prothrombin time(PT),(P=0.000、0.000、0.010). And there were not any significant in ascites and hepatic encephalopathy (P=0.113、0.113).Conclusions:1.Propranolol and carvedilol could induce the HVPG effectively. And the response rate of non-selective beta blocker was55.80%.2.Ascites, hepatic encephalopathy, and Child-Pugh score were not influence the reduction of HVPG by propranolol or carvedilol.3. The response rate of carvedilol was little higher than propranolol, but had no significant. The albumin(ALB), total bilirbin(TBIL) and prothrombin time could influence the reduction of HVPG by propranolol or carvedilol.