中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 6
Jun.  2022
Turn off MathJax
Article Contents

Etiological and non-etiological therapies for cirrhotic portal hypertension

DOI: 10.3969/j.issn.1001-5256.2022.06.003
Research funding:

Capital's Funds for Health Improvement and Research (2022-2-1104);

Digestive Medical Coordinated Development Center of Beijing Hospitals Authority (XXT04)

More Information
  • Corresponding author: WANG Yu, wangyuliver@ccmu.edu.cn (ORCID: 0000-0003-3025-1073)
  • Received Date: 2022-04-20
  • Accepted Date: 2022-05-22
  • Published Date: 2022-06-20
  • Portal hypertension is a serious complication of liver cirrhosis resulting from the increases in portal vascular resistance and portal blood inflow. Both etiological and non-etiological therapies can effectively reduce portal venous pressure to a certain degree, but with an unsatisfactory effect in improving prognosis. New therapeutic drugs targeting the reduction in intrahepatic vascular resistance may help to achieve the reversal of portal hypertension. Based on the pathogenesis of cirrhotic portal hypertension, this article summarizes the current pharmacotherapies from the aspects of etiological and non-etiological therapies, so as to provide a comprehensive theoretical and evidence-based basis for clinical treatment options.

     

  • loading
  • [1]
    TURCO L, GARCIA-TSAO G, MAGNANI I, et al. Cardiopulmonary hemodynamics and C-reactive protein as prognostic indicators in compensated and decompensated cirrhosis[J]. J Hepatol, 2018, 68(5): 949-958. DOI: 10.1016/j.jhep.2017.12.027.
    [2]
    TURCO L, GARCIA-TSAO G. Portal hypertension: pathogenesis and diagnosis[J]. Clin Liver Dis, 2019, 23(4): 573-587. DOI: 10.1016/j.cld.2019.07.007.
    [3]
    ABRALDES JG, TREBICKA J, CHALASANI N, et al. Prioritization of therapeutic targets and trial design in cirrhotic portal hypertension[J]. Hepatology, 2019, 69(3): 1287-1299. DOI: 10.1002/hep.30314.
    [4]
    SELICEAN S, WANG C, GUIXÉ-MUNTET S, et al. Regression of portal hypertension: underlying mechanisms and therapeutic strategies[J]. Hepatol Int, 2021, 15(1): 36-50. DOI: 10.1007/s12072-021-10135-4.
    [5]
    LAMPERTICO P, INVERNIZZI F, VIGANÒ M, et al. The long-term benefits of nucleos(t)ide analogs in compensated HBV cirrhotic patients with no or small esophageal varices: A 12-year prospective cohort study[J]. J Hepatol, 2015, 63(5): 1118-1125. DOI: 10.1016/j.jhep.2015.06.006.
    [6]
    LI CZ, CHENG LF, LI QS, et al. Antiviral therapy delays esophageal variceal bleeding in hepatitis B virus-related cirrhosis[J]. World J Gastroenterol, 2013, 19(40): 6849-6856. DOI: 10.3748/wjg.v19.i40.6849.
    [7]
    HSIEH YH, HUANG HC, CHANG CC, et al. Nucleos(t)ide analogs do not independently influence hepatic fibrosis and portal hypertension beyond viral suppression in CBDL-induced cirrhotic rat[J]. J Pharmacol Exp Ther, 2018, 367(2): 260-266. DOI: 10.1124/jpet.118.250431.
    [8]
    LENS S, BAIGES A, ALVARADO-TAPIAS E, et al. Clinical outcome and hemodynamic changes following HCV eradication with oral antiviral therapy in patients with clinically significant portal hypertension[J]. J Hepatol, 2020, 73(6): 1415-1424. DOI: 10.1016/j.jhep.2020.05.050.
    [9]
    WINTERS A, LUEDTKE S, MORELAND A, et al. In hepatitis C virus-related advanced fibrosis and cirrhosis, early decline of liver stiffness following antiviral therapywith DAAs is related to decline in liver inflammation[J]. J Hepatol, 2017, 66(1): S280.
    [10]
    PAN JJ, BAO F, DU E, et al. Morphometry confirms fibrosis regression from sustained virologic response to direct-acting antivirals for hepatitis C[J]. Hepatol Commun, 2018, 2(11): 1320-1330. DOI: 10.1002/hep4.1228.
    [11]
    SPAHR L, GOOSSENS N, FURRER F, et al. A return to harmful alcohol consumption impacts on portal hemodynamic changes following alcoholic hepatitis[J]. Eur J Gastroenterol Hepatol, 2018, 30(8): 967-974. DOI: 10.1097/MEG.0000000000001148.
    [12]
    BERZIGOTTI A, ALBILLOS A, VILLANUEVA C, et al. Effects of an intensive lifestyle intervention program on portal hypertension in patients with cirrhosis and obesity: The SportDiet study[J]. Hepatology, 2017, 65(4): 1293-1305. DOI: 10.1002/hep.28992.
    [13]
    RODRIGUES SG, MENDOZA YP, BOSCH J. Beta-blockers in cirrhosis: Evidence-based indications and limitations[J]. JHEP Rep, 2020, 2(1): 100063. DOI: 10.1016/j.jhepr.2019.12.001.
    [14]
    SINAGRA E, PERRICONE G, D'AMICO M, et al. Systematic review with meta-analysis: the haemodynamic effects of carvedilol compared with propranolol for portal hypertension in cirrhosis[J]. Aliment Pharmacol Ther, 2014, 39(6): 557-568. DOI: 10.1111/apt.12634.
    [15]
    ROCCARINA D, BEST LM, FREEMAN SC, et al. Primary prevention of variceal bleeding in people with oesophageal varices due to liver cirrhosis: a network meta-analysis[J]. Cochrane Database Syst Rev, 2021, 4: CD013121. DOI: 10.1002/14651858.CD013121.pub2.
    [16]
    YANG J, GE K, CHEN L, et al. The efficacy comparison of carvedilol plus endoscopic variceal ligation and traditional, nonselective β-blockers plus endoscopic variceal ligation in cirrhosis patients for the prevention of variceal rebleeding: a meta-analysis[J]. Eur J Gastroenterol Hepatol, 2019, 31(12): 1518-1526. DOI: 10.1097/MEG.0000000000001442.
    [17]
    de FRANCHIS R, BOSCH J, GARCIA-TSAO G, et al. Baveno Ⅶ - Renewing consensus in portal hypertension[J]. J Hepatol, 2022, 76(4): 959-974. DOI: 10.1016/j.jhep.2021.12.022.
    [18]
    VILLANUEVA C, ALBILLOS A, GENESCÀ J, et al. β blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, double-blind, placebo-controlled, multicentre trial[J]. Lancet, 2019, 393(10181): 1597-1608. DOI: 10.1016/S0140-6736(18)31875-0.
    [19]
    Chinese Society of Hepatology, Chinese Medical Association, XU X, et al. Chinese guidelines on the management of ascites and its related complications in cirrhosis[J]. Hepatol Int, 2019, 13(1): 1-21. DOI: 10.1007/s12072-018-09923-2.
    [20]
    PARK JH, JUN DW, CHOI J, et al. Low-dose propranolol as secondary prophylaxis for varix bleeding decreases mortality and rebleeding rate in patients with tense ascites[J]. J Clin Med, 2019, 8(5): 573. DOI: 10.3390/jcm8050573.
    [21]
    XU X, GUO X, de STEFANO V, et al. Nonselective beta-blockers and development of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis[J]. Hepatol Int, 2019, 13(4): 468-481. DOI: 10.1007/s12072-019-09951-6.
    [22]
    XU X, XU S, PRIMIGNANI M, et al. Nonselective β-blockers may progress the thrombosis of portal venous system in cirrhotic patients: a retrospective observational study[J]. Adv Ther, 2020, 37(4): 1452-1463. DOI: 10.1007/s12325-020-01250-z.
    [23]
    PERROS F, de MAN FS, BOGAARD HJ, et al. Use of β-blockers in pulmonary hypertension[J]. Circ Heart Fail, 2017, 10(4): e003703. DOI: 10.1161/CIRCHEARTFAILURE.116.003703.
    [24]
    BOSCH J, GRACIA-SANCHO J, ABRALDES JG. Cirrhosis as new indication for statins[J]. Gut, 2020, 69(5): 953-962. DOI: 10.1136/gutjnl-2019-318237.
    [25]
    GARCIA-TSAO G, ABRALDES JG, BERZIGOTTI A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology, 2017, 65(1): 310-335. DOI: 10.1002/hep.28906.
    [26]
    BUNCHORNTAVAKUL C, REDDY KR. Pharmacologic management of portal hypertension[J]. Clin Liver Dis, 2019, 23(4): 713-736. DOI: 10.1016/j.cld.2019.06.004.
    [27]
    ZHOU X, TRIPATHI D, SONG T, et al. Terlipressin for the treatment of acute variceal bleeding: A systematic review and meta-analysis of randomized controlled trials[J]. Medicine (Baltimore), 2018, 97(48): e13437. DOI: 10.1097/MD.0000000000013437.
    [28]
    SRIDHARAN K, SIVARAMAKRISHNAN G. Vasoactive agents for the management of variceal bleeding: a mixed treatment comparison network meta-analysis and trial sequential analysis of randomized clinical trials[J]. Drug Res (Stuttg), 2019, 69(9): 487-495. DOI: 10.1055/a-0846-3071.
    [29]
    FACCIORUSSO A, CHANDAR AK, MURAD MH, et al. Comparative efficacy of pharmacological strategies for management of type 1 hepatorenal syndrome: a systematic review and network meta-analysis[J]. Lancet Gastroenterol Hepatol, 2017, 2(2): 94-102. DOI: 10.1016/S2468-1253(16)30157-1.
    [30]
    CAVALLIN M, PIANO S, ROMANO A, et al. Terlipressin given by continuous intravenous infusion versus intravenous boluses in the treatment of hepatorenal syndrome: A randomized controlled study[J]. Hepatology, 2016, 63(3): 983-992. DOI: 10.1002/hep.28396.
    [31]
    ISRAELSEN M, KRAG A, ALLEGRETTI AS, et al. Terlipressin versus other vasoactive drugsfor hepatorenal syndrome[J]. Cochrane Database Syst Rev, 2017, 9(9): CD011532. DOI: 10.1002/14651858.CD011532.pub2.
    [32]
    CAVALLIN M, KAMATH PS, MERLI M, et al. Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome: arandomized trial[J]. Hepatology, 2015, 62(2): 567-574. DOI: 10.1002/hep.27709.
    [33]
    CERINI F, VILASECA M, LAFOZ E, et al. Enoxaparin reduces hepatic vascular resistance and portal pressure in cirrhotic rats[J]. J Hepatol, 2016, 64(4): 834-842. DOI: 10.1016/j.jhep.2015.12.003.
    [34]
    GUIXÉ-MUNTET S, ZHU CP, XIE WF, et al. Novel therapeutics for portal hypertension and fibrosis in chronic liver disease[J]. Pharmacol Ther, 2020, 215: 107626. DOI: 10.1016/j.pharmthera.2020.107626.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Article Metrics

    Article views (629) PDF downloads(217) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return