背景：内脏动脉血管扩张在肝硬化腹水中起着重要作用。本研究的目的是评估长期服用米多君在肝硬化顽固性或复发性腹水患者的全身血流动力学、肾功能和腹水控制方面的影响。方法：在一所三级医疗中心，前瞻性研究40例肝硬化顽固性或复发性腹水患者，在该项随机对照试验当中，分为长期服用米多君加常规药物治疗组（20例）或单独常规药物治疗组（20例）。结果：服用米多君1个月后，尿量、尿钠排泄、平均动脉压显著增加，血浆肾素活性显著降低（p<0.05）。米多君治疗3个月后，亦有心输出量显著降低和外周血管阻力显著增加（p<0.05），但肾小球滤过率和终末期肝病模型（MELD）评分没有改变。在控制腹水上，3个月米多君加常规药物治疗显著优于单独常规药物治疗（p=0.013）。常规药物治疗组的死亡率显著高于米多君组（p<0.046）。随访结束后两组中各种并发症的发生率无显著差异。结论：该项随机试验研究的结果表明，米多君加常规药物治疗可改善这些患者的全身血流动力学，而无任何肝肾功能紊乱，并且较单独常规药物治疗更有效的控制腹水。
江西省景德镇市第三人民医院消化内科 朱晓佳，杨力 摘译
本文首次发表于[ J Hepatol，2012，56(2): 348-354]
Midodrine in patients with cirrhosis and refractory or recurrent ascites: a randomized pilot study
BACKGROUND & AIMS:
Splanchnic arterial vasodilatation plays an important role in cirrhotic ascites. The aim of this study was to evaluate the effects of long term administration of midodrine on systemic hemodynamics, renal function, and control of ascites in patients with cirrhosis and refractory or recurrent ascites.
METHODS:
Forty cirrhotic patients with refractory or recurrent ascites were prospectively studied after long term administration of midodrine plus standard medical therapy (n=20) or standard medical therapy alone (n=20) in a randomized controlled trial at a tertiary centre.
RESULTS:
A significant increase in urinary volume, urinary sodium excretion, mean arterial pressure, and decrease in plasma renin activity (p<0.05) was noted after 1 month of midodrine administration. There was also a significant decrease in cardiac output and an increase in systemic vascular resistance after midodrine therapy at 3 months (p<0.05). There was no change in glomerular filtration rate and model for end-stage liver disease (MELD) score. Midodrine plus standard medical therapy was significantly superior to standard medical therapy alone in the control of ascites(p=0.013) at 3 months. The mortality rate in the standard medical therapy group was significantly higher than the midodrine group (p<0.046). There was no significant difference in the frequency of various complications at the end of follow-up.
CONCLUSIONS:
The results of this randomized pilot study suggest that midodrine plus standard medical therapy improves the systemic hemodynamics without any renal or hepatic dysfunction in these patients and is superior to standard medical therapy alone for the control of ascites.
