肝硬化低钠血症与Vaptans  

Hyponatremia in cirrhosis and vaptans

作　　者：向慧玲[1] 

机构地区：[1]天津市第三中心医院消化内科天津市人工细胞重点实验室,天津市300170

出　　处：《世界华人消化杂志》2010年第12期1244-1249,共6页World Chinese Journal of Digestology

摘　　要：低钠血症是晚期肝硬化的常见并发症,包括:低血容量性低钠血症和高血容量性,即稀释性低钠血症.前者以低血钠、低血容量、脱水及肾前性肾功能不全为特征,不伴浮肿和腹水;后者以有效血循环不足,稀释性低血钠为特征,伴有浮肿和腹水.低钠血症与肝硬化的各种并发症及肝移植术后近期死亡率密切相关.Vaptans是一类选择性非肽类精氨酸加压素(AVP)受体拮抗剂类药物,通过与肾脏集合管上AVPV2竞争性结合,抑制肾脏集合管对水的重吸收,达到排水利尿作用(水利尿),不增加电解质的排泄.已有多项临床试验评价Vaptans在低钠血症中的作用.短期应用Vaptans可以显著增加患者无溶质水的排出,纠正低钠血症,没有明显不良反应.Vaptans被认为是肝硬化低钠血症治疗上的里程碑.Hyponatremia is a common problem in patients with advanced cirrhosis.Hyponatremia in cirrhosis includes two distinct types：hypovolemic hyponatremia,and hypervolemic or dilutional hyponatremia.The former is characterized by low blood sodium,low blood volume,dehydration and prerenal renal dysfunction,not accompanied by edema and ascites,while the latter is characterized by insufficient circulatory volume and dilutional hyponatremia,accompanied by edema and ascites.Hyponatremia is closely related to various complications of cirrhosis and to early mortality after liver transplantation.Vaptans,a class of selective non-peptide arginine vasopressin （AVP） receptor antagonists,act by antagonizing specifically the effects of AVP V2 receptor located in the renal collecting tubules to inhibit water reabsorption without affecting electrolytes excretion.Vaptans has been evaluated by several clinical trials for their role in the management of hyponatremia.The shortterm treatment with vaptans is associated with a marked increase in renal solute-free water excretion and improvement of hyponatremia with no apparent adverse reactions.The discovery of vaptans is considered a new milestone in the management of hyponatremia in cirrhosis.

关 键 词：肝硬化 低钠血症 VAPTANS 

分 类 号：R575.2[医药卫生—消化系统]