托伐普坦治疗肾病综合征患者水肿的疗效与安全性  

Efficacy and safety of tolvaptan therapy for edema in patients with nephrotic syndrome

作　　者：叶楠[1] 程虹[1] 王国勤[1] 马骏骉[1] 谌贻璞[1] Ye Nan;Cheng Hong;Wang Guoqin;Ma Junbiao;Chen Yipu.(Department of Nephrology, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院肾内科,北京100029

出　　处：《中华肾脏病杂志》2018年第4期274-280,共7页Chinese Journal of Nephrology

摘　　要：目的观察与评价托伐普坦治疗肾病综合征（NS）患者水肿的近期疗效与安全性。方法纳入非低血容量、血钠正常的NS水肿12例患者为研究对象。吲哚菁绿．脉搏染料光密度法检测血容量。口服托伐普坦利尿治疗，起始剂量15mg／d，渐加量至30mg／d，疗程7d，观察托伐普坦的利尿效果及电解质紊乱（高钠血症）、血栓栓塞并发症、低血压和（或）急性肾损害等不良反应。结果与治疗前相比，托伐普坦治疗后患者尿量显著增加（F=5．792，P〈0．001），体重显著下降（F=24．086，P〈0．001）；血钠上升[（141．1±0．5）mmol／L比（139．1±0．6）mmol／L，P〈0．001]，有3例次（3．6％）患者出现轻度高钠血症（最高146．5mmol／L），停服托伐普坦1d后血钠恢复正常，恢复用药。治疗过程中无血栓栓塞、低血压和（或）急性肾损害等不良反应发生。结论托伐普坦15—30mg／d短期治疗非低血容量、血钠正常的Ns水肿可获得良好利尿效果，无严重不良反应发生。Objective To evaluate the efficacy and safety of tolvaptan therapy for edema in patients with nephrotic syndrome （NS）. Methods Twelve patients with NS who had normal serum sodium and blood volume were enrolled. All of them were treated with oral tolvaptan of 15-30 mg per day for 7 days. The diuretic effects were observed and the adverse reactions including electrolyte disorders （especially hypernatremia）, low blood volume, thromboembolic complications, and acute kidney injury were closely monitored. Results The average urine volume was significantly increased （F=5.792, P 〈 0.001） and the body weight was significantly decreased （F=24.086, P 〈 0.001） from the first day of tolvaptan therapy until the end of the treatment. The average serum sodium levels were significantly increased from the second day of tolvaptan therapy until the end of the treatment （F= 2.790, P=0.012）, but only 3 case-times （3.6%） among the total 84 case-times of serum sodium tests showed mild hypernatremia （the highest level 146.5 mmol/L） and all the hypernatremia returned back to normal after suspending tolvaptan for one day. There were no significant changes in the serum potassium levels （F=0.477, P=0.849） within the whole treatment course. There was also no significant difference of the blood volume between the level at the end of treatment and the baseline level [（74.3±3.0） ml/kg vs （74.9±3.0） ml/kg, P=0.855]. The thromboembolic complications and acute kidney injury both also did not take place. Conclusions As long as a rational and prudent treatment regimen is applied, tolvaptan has good diuretic effects and safety for treatment of edema in the NS patients with normal serum sodium and blood volume.

关 键 词：肾病综合征 利尿 高钠血症 托伐普坦 血容量 

分 类 号：R692[医药卫生—泌尿科学]