托伐普坦在心力衰竭临床应用及关于水通道蛋白-2基因多态性的研究  

Clinical Usage of Tolvaptan in Heart Failure Patients and Researches about Gene Polymorphism of Aquporin-2

作　　者：张佳雨[1] 潘丽华[2] 秦晓同[2] 桂乐[2] 

机构地区：[1]南通大学研究生院,江苏南通226001 [2]南通大学附属医院心血管内科,江苏南通226001

出　　处：《心血管病学进展》2017年第3期296-299,共4页Advances in Cardiovascular Diseases

基　　金：南通市卫计委青年医学人才科研基金(WQ2016076)

摘　　要：心力衰竭是心内科许多疾病的终末期临床表现,传统的利尿治疗在终末期患者的应用往往效果欠佳。课题组对心力衰竭的发病机制做过许多研究,包括交感神经兴奋性的增强、体液因子的改变、肾素-血管紧张素-醛固酮系统及下丘脑-垂体系统的激活等。近年来随着水通道蛋白的发现,精氨酸血管加压素-精氨酸血管加压素V2型受体-水通道蛋白-2系统在心力衰竭水钠潴留中的作用日渐受到相关学者重视。而托伐普坦作为精氨酸加压素2型拮抗剂的代表,其在慢性心力衰竭患者的应用尤其是在终末期心力衰竭患者的应用越来越多;但是在观察了一些心力衰竭患者使用托伐普坦的治疗效果后,发现不同患者对于该药物的剂量反应的差异性较大。故推测人群中因水通道蛋白-2的基因多态性造成水通道蛋白-2表达的差异可能是造成这一现象的主要因素之一。因此查询了关于托伐普坦在慢性心力衰竭患者的临床应用及水通道蛋白-2基因多态性研究的相关文献,并予以综述。Heart failure is the end-stage clinical manifestation of many cardiovascular diseases. Traditional diuretic therapies, such as furosemide,were often ineffective on end-stage patients. Our group has conducted significant research on the pathogenesis of heart failure, ineluding enhancement of the sympathetic nerve, change of humoral factors, activation of renin-angiotensin-aldosterone system and hypothalamo- hypophysial system. With the discovery of aquaporin, there is increasing recognition of the arginine vasopressin-arginine vasopressin V2 recep- tor-aquaporin-2 （AVP-AVPR2-AQP-2） system＇s function, which leads to the retention of water and natrium in heart failure. As the representative drug of AVPR2 receptor antagonist,Tolvaptan has an increasing usage in chronic heart failure patients, especially in end-stage heart failure patients. However,after observing the effects of a few cases ,we found that different patients exhibit large differences in response to tolvaptan doses. Therefore we infer that the gene polymorphism of AQP-2 causes the difference of AQP-2＇s expression and this may be one of the major factors. Our review discusses our observations and research into tolvaptan＇s treatment for chronic heart failure and literature regarding the gene polymorphism of AQP-2.

关 键 词：水通道蛋白-2 托伐普坦 心力衰竭 低钠血症 基因多态性 

分 类 号：R541.6[医药卫生—心血管疾病] R972[医药卫生—内科学]