托伐普坦治疗慢性心力衰竭合并低钠血症的效果  

Efficacy and Safety of Tolvaptan for Heart Failure and Hyponatremia

作　　者：孟海娜[1] 谢嘉怡[1] 何微 MENG Haina;XIE Jiayi;HE Wei(Department of Cardiology,Shengjing Hospital,China Medical University,Shenyang,110004)

机构地区：[1]中国医科大学附属盛京医院心内科

出　　处：《中国医科大学学报》2019年第6期551-554,共4页Journal of China Medical University

基　　金：辽宁省2018年重点研发计划指导计划(201800694)

摘　　要：目的探讨托伐普坦治疗顽固性慢性心力衰竭(简称心衰)合并低钠血症的有效性及安全性。方法回顾性分析2015年3月至2016年3月于我院心内科住院的67例慢性心衰合并低钠血症病例。根据住院期间是否应用托伐普坦将其分为托伐普坦组(n=29)和标准治疗组(n=38)。观察住院期间患者血清钠离子浓度、脑钠肽前体(NT-proBNP)的改善情况,以及平均住院时间和院内死亡情况,并随访1年观察患者的心脏不良事件。结果托伐普坦组出院前NT-proBNP降低程度[(5525.29±5432.88)pg/L]显著大于标准治疗组[(3198.65±3373.90)pg/L),血钠浓度提升程度[(6.37±5.01)mmol/L]也明显优于标准治疗组[(1.06±3.96)mmol/L)],差异均有统计学意义(P<0.05)。心衰合并低钠血症患者平均住院时间为(13.51±7.23)d,托伐普坦组为(11.24±4.24)d,标准治疗组为(15.24±8.52)d,差异有统计学意义(P=0.015);全部患者院内死亡率为11.9%,托伐普坦组为10.3%,标准治疗组为13.2%。托伐普坦组1年内因心衰再住院率及死亡率分别为42.3%及30.8%,标准治疗组分别为66.7%及36.4%,差异均无统计学意义(P>0.05)。结论对于慢性心衰合并低钠血症的患者,短期口服托伐普坦可改善心衰症状,升高血清钠浓度,改善心功能,不良反应较少,耐受性良好,但对患者远期心血管事件可能影响不大。Objective To evaluate the efficacy and safety of tolvaptan for heart failure and hyponatremia.Methods Between March 2015 and March 2016,we selected 67 patients with chronic heart failure(CHF)and hyponatremia who were hospitalized in Shengjing Hospital,China Medical University,among which one group was treated with tolvaptan(tolvaptan group,n=29),and the other was provided a standard treatment(standard treatment group,n=38).The concentration of serum sodium and amino terminal B-type natriuretic peptide precursor(NT-proBNP)were evaluated,and the average length of hospital stay and hospital mortality rate were noted.We then evaluated the number of adverse cardiac events in these patients after one-year of follow-up.Results In the tolvaptan group,the NT-proBNP concentration had decreased and serum sodium concentration had increased more than that in the standard treatment group(P<0.05).The average lengths of the hospital stay were 13.51±7.23,11.24±4.24,and 15.24±8.52 days for all patients,the tolvaptan group,and the standard treatment group,respectively,whereas the hospital mortality rates were 11.9%,10.3%,and 13.2%,respectively.The readmission and mortality rates within one year were not significantly different between the two groups.Conclusion For patients with CHF and hyponatremia,short-term oral administration of tolvaptan improved patient health,heart function,and the concentration of serum sodium,with fewer adverse effects and better tolerance.However,the long-term benefits remain unclear.

关 键 词：心力衰竭 低钠血症 托伐普坦 

分 类 号：C320.2410[社会学]