Severe complications of liver cirrhosis are mostly related to portal hypertension. At the base of the pathogenesis of portal hypertension is the increase in hepatic vascular resistance to portal blood flow with subseq...Severe complications of liver cirrhosis are mostly related to portal hypertension. At the base of the pathogenesis of portal hypertension is the increase in hepatic vascular resistance to portal blood flow with subsequent development of hyperdynamic circulation, which, despite of the formation of collateral circulation, promotes progression of portal hypertension. An important role in its pathogenesis is played by the rearrangement of vascular bed and angiogenesis. As a result, strategic directions of the therapy of portal hypertension under liver cirrhosis include selectively decreasing hepatic vascular resistance with preserving or increasing portal blood flow, and correcting hyperdynamic circulation and pathological angiogenesis, while striving to reduce the hepatic venous pressure gradient to less than 12 mm Hg or 20% of the baseline. Over the last years, substantial progress in understanding the pathophysiological mechanisms of hemodynamic disorders under liver cirrhosis has resulted in the development of new drugs for their correction. Although the majority of them have so far been investigated only in animal experiments, as well as at the molecular and cellular level, it might be expected that the introduction of the new methods in clinical practice will increase the efficacy of the conservative approach to the prophylaxis and treatment of portal hypertension complications. The purpose of the review is to describe the known methods of portal hypertension pharmacotherapy and discuss the drugs that may affect the basic pathogenetic mechanisms of its development.展开更多
文摘目的:探讨经皮冠状动脉介入(percutaneous coronary intervention,PCI)和药物治疗对冠心病(coronary heart disease,CHD)患者生活质量和认知功能的影响及其区别,以及生活质量与认知功能的关系。方法:从冠状动脉造影患者中选取PCI的CHD患者160例(PCI组),药物治疗的CHD患者160例(药物治疗组)。采用健康调查表SF-36(Shortform-36 Health Survey)和西雅图心绞痛问卷(Seatt le Angina Questionnaire,SAQ)评估患者的生活质量,采用简易智能精神状态检查量表(Mini-Mental State Examination,MMSE)评估患者的认知功能。在完成冠状动脉造影术当天收集患者的一般资料。治疗后1个月进行电话随访,3个月和6个月通知门诊复查。结果:共收回有效问卷309份。PCI组和药物治疗组生活质量评分均比治疗前高(均P<0.05)。PCI组生理职能、躯体疼痛、精力、精神健康这4个维度的SF-36评分均比药物治疗组高(均P<0.05)。术后6个月PCI组心绞痛稳定状态、心绞痛发作频率这2个维度的SAQ评分均比药物治疗组高(均P<0.05)。两组患者治疗前后认知功能差异均无统计学意义(均P>0.05)。两组之间的认知功能差异亦无统计学意义(P>0.05)。PCI组生理机能、生理职能、躯体疼痛、情感智能与认知功能呈正相关关系(分别r=0.207,0.182,0.184,0.176,均P<0.05),药物治疗组生活质量与认知功能无相关关系。结论:PCI组和药物治疗组患者的生活质量均得到改善,但PCI组改善更明显。PCI和药物治疗均未出现认知功能下降,且两组间无差异。PCI组生活质量与认知功能呈正相关关系,药物治疗组生活质量与认知功能无相关关系。
文摘Severe complications of liver cirrhosis are mostly related to portal hypertension. At the base of the pathogenesis of portal hypertension is the increase in hepatic vascular resistance to portal blood flow with subsequent development of hyperdynamic circulation, which, despite of the formation of collateral circulation, promotes progression of portal hypertension. An important role in its pathogenesis is played by the rearrangement of vascular bed and angiogenesis. As a result, strategic directions of the therapy of portal hypertension under liver cirrhosis include selectively decreasing hepatic vascular resistance with preserving or increasing portal blood flow, and correcting hyperdynamic circulation and pathological angiogenesis, while striving to reduce the hepatic venous pressure gradient to less than 12 mm Hg or 20% of the baseline. Over the last years, substantial progress in understanding the pathophysiological mechanisms of hemodynamic disorders under liver cirrhosis has resulted in the development of new drugs for their correction. Although the majority of them have so far been investigated only in animal experiments, as well as at the molecular and cellular level, it might be expected that the introduction of the new methods in clinical practice will increase the efficacy of the conservative approach to the prophylaxis and treatment of portal hypertension complications. The purpose of the review is to describe the known methods of portal hypertension pharmacotherapy and discuss the drugs that may affect the basic pathogenetic mechanisms of its development.
