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首页> 外文期刊>Liver international : >All beta-blockers are created equal, but some beta-blockers are more equal than others
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All beta-blockers are created equal, but some beta-blockers are more equal than others

机译：所有β受体阻滞剂的创造都是平等的，但有些β受体阻滞剂比其他β受体阻滞剂更平等

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摘要

Portal hypertensive-associated variceal bleeding in advanced cirrhosis carries a high mortality, and thus the landmark observation by Lebrec et al. (1) that beta-blockade with propranolol could significantly reduce the incidence of first variceal bleeding has defined the standard of care for the last three decades. Numerous mechanistic studies and clinical trials have followed showing that administration of non-selective beta-blockers (NSBB) results in both a decrease in cardiac output, because of (31 adrenoceptor blockade, and in addition a blockade of vasodilatory (32 receptors in the splanchnic circulation, resulting in decreased splanchnic blood flow, collectively lowering portal pressure. However, the lack of receptor selectivity with these agents leads to adverse events limiting the tolerance to this class of agent, and also partially accounts for the reported limited efficacy of NSBB, which is around 40 -50 per cent. Moreover, experimental data in rodent models show that (31 receptors are relatively down-regulated in cirrhosis with a greater predominance of (32 (2), perhaps also suggesting that the dose of NSBB is likely to be important and that in clinical studies, lack of clarity of achieving optimal dose may further cloud the interpretation of efficacy data.
机译：晚期肝硬化中的门脉高压相关静脉曲张破裂出血具有很高的死亡率，因此Lebrec等人的研究具有里程碑意义。 （1）普萘洛尔的β受体阻滞剂可显着降低首次静脉曲张破裂出血的发生率，这已定义了最近三十年的护理标准。随后进行的许多机理研究和临床试验表明，非选择性β-受体阻滞剂（NSBB）的使用会导致心输出量降低，原因是（31个肾上腺素受体阻滞剂，以及内脏中的32个血管舒张剂循环，导致内脏血流量减少，共同降低门脉压力;但是，这些药物缺乏受体选择性会导致不良事件，从而限制了对该药物的耐受性，也部分归因于已报道的NSBB疗效有限大约有40 -50％。此外，啮齿动物模型的实验数据表明（在肝硬化中31个受体相对下调，主要是（32）[2]，这也可能表明NSBB的剂量可能是重要的是，在临床研究中，缺乏获得最佳剂量的明确性可能会进一步模糊功效数据的解释。

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