托伐普坦治疗肝硬化顽固性腹水并低钠血症的疗效

doi:10.6040/j.issn.1671-7554.0.2015.392

摘要/Abstract

摘要： 目的评价托伐普坦治疗肝硬化顽固性腹水合并低钠血症的疗效和安全性。方法 62例肝硬化顽固性腹水合并低钠血症患者随机分为托伐普坦组和常规利尿剂组。分别每日服用15 mg托伐普坦片或常规利尿剂。观察点为治疗前1天(基线)、治疗第4天及治疗第7天,主要观察项目包括血清钠、氯、钾、CO₂CP等生化指标,尿量、腹围、体质量以及ALT、TBIL等肝功指标,BUN、Cr、eGFR等肾功指标。结果治疗第4、7天,托伐普坦组血钠值分别为(132.8±6.3)、(133.3±6.9)mmol/L,显著优于常规利尿剂组(128.8±6.0)、(129.4±6.6)mmol/L(P<0.05)。托伐普坦组尿量增加和体质量、腹围下降均优于常规利尿剂组(P<0.05)。两组患者治疗前后肝功、肾功、血压和心率变化差异无统计学意义(P>0.05)。结论托伐普坦可有效纠正肝硬化顽固性腹水患者低钠血症,增加尿量,改善液体平衡,对肝肾功能无不良影响。

关键词: 托伐普坦, 肝硬化, 低钠血症, 顽固性腹水

Abstract: Objective To evaluate the efficacy and safety of tolvaptan in treating refractory ascites and hyponatremia due to cirrhosis compared with conventional therapy. Methods A total of 62 cases of liver cirrhosis with refractory ascites and hyponatremia were randomly divided into the tolvaptan group and routine diuretic group, which were given a daily dose of 15mg tolvaptan tablets or conventional diuretics, respectively. The observation points were 1-day before treatment(baseline), day 4 and day 7 during the treatment. Biochemical indicators(e.g., serum sodium, chlorine, potassium, carbon dioxide combining power), liver function(e.g., alanine aminotransferase and total bilirubin), renal function(e.g., urea nitrogen, carbon dioxide combining power and glomerular filtration rate), urine output, abdominal circumference and body mass index were recorded and compared. Results On day 4 and day 7, the averages serum sodium in the tolvaptan group were(132.8±6.3)mmol/L and(133.3±6.9)mmol/L, which were significantly higher than those in the routine diuretic group ［(128.8±6.0)mmol/L and(129.4±6.6)mmol/L)］,(P<0.05). The average urine volume in the tolvaptan group was remarkably higher than that in the routine diuretic group(P<0.05). The average body weight and abdominal circumference of the tolvaptan group were markedly less than those of the routine diuretic group(P<0.05). There were no statistically significant differences in liver function, renal function, blood pressure and heart rate before and after treatment in both groups(P>0.05). Conclusion Tolvaptan can effectively correct the refractory ascites and hyponatremia, increase urine volume and improve liquid equilibrium of patients with liver cirrhosis without damaging liver and kidney function.

Key words: Tolvaptan, Refractory ascites, Hyponatremia, Cirrhosis

中图分类号:

R575

刘彩峰, 汪明明, 李新立, 崔速南. 托伐普坦治疗肝硬化顽固性腹水并低钠血症的疗效[J]. 山东大学学报（医学版）, 2016, 54(1): 33-37.

LIU Caifeng, WANG Mingming, LI Xinli, CUI Sunan. Efficacy of tolvaptan in the treatment of cirrhosis complicated with refractory ascites and hyponatremia[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(1): 33-37.

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