Efficacy of tolvaptan in patients with refractory ascites in a clinical setting  

作　　者：Takamasa Ohki Koki Sato Tomoharu Yamada Mari Yamagami Daisaku Ito Koki Kawanishi Kentaro Kojima Michiharu Seki Nobuo Toda Kazumi Tagawa 

机构地区：[1]Department of Gastroenterology, Mitsui Memorial Hospital

出　　处：《World Journal of Hepatology》2015年第12期1685-1693,共9页世界肝病学杂志（英文版）（电子版）

摘　　要：AIM: To elucidate the efficacies of tolvaptan(TLV) as a treatment for refractory ascites compared with conventional treatment. METHODS: We retrospectively enrolled 120 refractory ascites patients between January 1, 2009 and September 31, 2014. Sixty patients were treated with oral TLV at a starting dose of 3.75 mg/d in addition to sodium restriction(> 7 g/d), albumin infusion(10-20 g/wk), and standard diuretic therapy(20-60 mg/d furosemide and 25-50 mg/d spironolactone) and 60 patients with large volume paracentesis in addition to sodium restriction(less than 7 g/d), albumin infusion(10-20 g/wk), and standard diuretic therapy(20-120 mg/d furosemide and 25-150 mg/d spironolactone). Patient demographics and laboratory data, including liver function, were not matched due to the small number of patients. Continuous variables were analyzed by unpaired t-test or paired t-test. Fisher's exact test was applied in cases comparing two nominal variables. We analyzed factors affecting clinical outcomes using receiver operating characteristic curves and multivariate regression analysis. We also used multivariate Cox's proportional hazard regression analysis to elucidate the risk factors that contributed to the increased incidence of ascites.RESULTS: TLV was effective in 38(63.3%) patients. The best cut-off values for urine output and reduced urine osmolality as measures of refractory ascites improvement were > 1800 mL within the first 24 h and > 30%, respectively. Multivariate regression analysis indicated that > 25% reduced urine osmolality [odds ratio(OR) = 20.7; P < 0.01] and positive hepatitis C viral antibodies(OR = 5.93; P = 0.05) were positively correlated with an improvement of refractory ascites, while the total bilirubin level per 1.0 mg/dL(OR = 0.57;P = 0.02) was negatively correlated with improvement. In comparing the TLV group and controls, only the serum sodium level was significantly lower in the TLV group(133 mE q/L vs 136 mE q/L; P = 0.02). However, there were no significant differences in the other parameterAIM To elucidate the efficacies of tolvaptan （TLV）as a treatment for refractory ascites compared withconventional treatment.METHODS： We retrospectively enrolled 120 refractoryascites patients between January 1, 2009 and September31, 2014. Sixty patients were treated with oral TLVat a starting dose of 3.75 mg/d in addition to sodiumrestriction （〉 7 g/d）, albumin infusion （10-20 g/wk）, andstandard diuretic therapy （20-60 mg/d furosemide and25-50 mg/d spironolactone） and 60 patients with largevolume paracentesis in addition to sodium restriction（less than 7 g/d）, albumin infusion （10-20 g/wk）, andstandard diuretic therapy （20-120 mg/d furosemide and25-150 mg/d spironolactone）. Patient demographicsand laboratory data, including liver function, werenot matched due to the small number of patients.Continuous variables were analyzed by unpaired t -testor paired t -test. Fisher＇s exact test was applied in casescomparing two nominal variables. We analyzed factorsaffecting clinical outcomes using receiver operatingcharacteristic curves and multivariate regressionanalysis. We also used multivariate Cox＇s proportionalhazard regression analysis to elucidate the risk factorsthat contributed to the increased incidence of ascites.RESULTS： TLV was effective in 38 （63.3%） patients.The best cut-off values for urine output and reducedurine osmolality as measures of refractory ascitesimprovement were 〉 1800 mL within the first 24 h and〉 30%, respectively. Multivariate regression analysisindicated that 〉 25% reduced urine osmolality [oddsratio （OR） = 20.7; P 〈 0.01] and positive hepatitis Cviral antibodies （OR = 5.93; P = 0.05） were positivelycorrelated with an improvement of refractory ascites,while the total bilirubin level per 1.0 mg/dL （OR = 0.57;P = 0.02） was negatively correlated with improvement.In comparing the TLV group and controls, only theserum sodium level was significantly lower in the TLVgroup （133 mEq/L vs 136 mEq/L; P = 0.02）. However,there were no signi

关 键 词：REFRACTORY ASCITES TOLVAPTAN PARACENTESIS DECOMPENSATED CIRRHOSIS 

分 类 号：R575[医药卫生—消化系统]