Effect Of Carvedilol On Portal Venous Haemodynamic And Hepatic Venous Pressure Gradient In Liver Cirrhosis

Objective:A major cause of cirrhosis-related morbidity and mortality is the development of variceal hemorrhage,a direct consequence of portal hypertension. Non-selectiveβ-blocker is first choice for preventing first variceal bleeding and re-bleeding in patients with cirrhosis. Carvedilol is a potent noncardioselectiveβ-blocker, with weak vasodilating properties because ofα1 blockade. Carvedilol has been investigated in several clinical hemodynamic studies and promises to be more effective than porpranolol. Now we will study the effect of carvedilol on portal venous haemodynamic and hepatic venous pressure gradient in liver cirrhosis,and provide more bases for the clinical useness of carvedilol.Methods:We collected 33patient,and 30 of them finished the experiment.A total of one week treatment on 33 patients (21 males and 12 females,mean age 54.2)with portal hypertension was performed.An initial dose 12.5mg qd of carvedilol was administrated。Gradually adjust the dose until the heart rate decrease 25% or to 55/min. The blood vessel diameter, blood flow velocity, blood flow of the portal vein, splenic vein and superior mesenteric vein were measured by Doppler ultrasonography before and after carvedilol was administered orally.The Hepatic Venous Pressure Gradient was also measured。Close observation of vital signs and adverse reactions in patients was performed. Statistical analyses were performed by use of SPSS 16.0 software. Results:3 of the 33 patient suffered from a dizziness and hypotension after carvedilol,and one of them quited.There were other 2 patients lost of follow up。30 patients finished the experiment.Consequences follow from this:(1)After administration of carvedilol,there was a reduction in hepatic venous pressure gradient (HVPG) from 13.02±4.49mmHg to 10.61±4.86 mmHg (p=0.002).And a fall in the HVPG to≤12mmHg or a 20% reduction from baseline values was observed in 12 patients.(2)①Before drug treatment hepatic portal vein diameter (Dpv) was 1.37±0.24cm, after 1 week treated with carvedilol the result was 1.32±0.20cm,compared with the baseline there was significant decrease (P=0.040); Before drug treatment the velocity of portal vein (Vpv) was 17.70+4.00cm/s, after 1 week treated with carvedilol the result was 15.22±5.10 cm/s, compared with the baseline there was a significant decrease (P=0.008); Before drug treatment blood flow quantity of portal vein (Qpv) was 15.95±5.66ml/s, after 1 week treated with carvedilol the result wasl2.47±4.80ml/s, compared with the baseline there was a significant decrease (P=0.002);②Before drug treatment splenic vein diameter (Dsv) was 1.07±0.26cm, after 1 week treated with carvedilol the result was 1.05±0.28cm, compared with the baseline there was no significant decrease (P=0.454); Before drug treatment splenic vein blood flow velocity (Vsv) was23.55±6.00cm/s, after 1 week treated with carvedilol the result was18.89±4.21cm/s. compared with the baseline there was a significant decrease (P=0.0002); Before drug treatment blood flow quantity of blood flow quantity of splenic vein (Qsv) was13.07±6.24ml/s, after 1 week treated with carvedilol the result was 10.60±6.57ml/s, compared with the baseline there was a significant decrease (P=0.025);③Before drug treatment superior mesenteric vein diameter (Dsmv) was 1.01±0.24cm, after 1 week treated with carvedilol the result was0.98±0.22cm, compared with the baseline there was no significant decrease (P=0.447); Before drug treatment superior mesenteric vein blood flow velocity (Vsmv) was34.91±13.26cm/s, after 1 week treated with carvedilol the result was 33.28±14.61cm/s, compared with the baseline there was no significant decrease (P=0.371); Before drug treatment blood flow quantity of Superior mesenteric vein (Qsmv) was16.40±8.52ml/s, after 1 week treated with carvedilol the result was 14.76±7.57ml/s, compared with the baseline there was no significant decrease (P=0.315);(3) 3 of the 33 patient suffered from a dizziness and hypotension after carvedilol,and one of them quited.There were other 2 patients lost of follow up,No other severe drug adverse reaction was observed.Conclusion:the results of the study indicated that: Carvedilol can reduce the vesse blood flow velocity and blood flow quantity of portal vein and splenic vein in some way,so hepatic venous pressure (HVPG) gradient decrease in turn., and has an effective rate about 40%.Non-selectiveβ-blocker carvedilol can be therapy for portal hypertension,when administered in early stages with a good effect and fewer side effects.