托伐普坦治疗急性充血性心力衰竭合并慢性肾功能不全的临床疗效研究  

Clinical e fficacy of tolvaptan in patients with acute congestiveheart failure complicated with chronic kidney disease

作　　者：易善婷 陈琳琳 王小芳[1] Shan-ting Yi;Lin-lin Chen;Xiao-fang Wang(Department of Cardiology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院心内科,河南郑州450052

出　　处：《中国现代医学杂志》2020年第11期92-97,共6页China Journal of Modern Medicine

摘　　要：目的探讨托伐普坦治疗急性充血性心力衰竭合并慢性肾功能不全的临床疗效。方法回顾性分析2018年8月-2019年5月郑州大学第一附属医院心内科重症监护室98例患者的临床资料,根据是否服用托伐普坦分为托伐普坦组(47例)和对照组(51例)。托伐普坦组在对照组治疗方案上加服托伐普坦,剂量为7.5~15.0 mg/d,1次/d。比较治疗前、治疗后1周和1个月心功能、肾功能、电解质等指标的变化;评估两组患者肾功能恶化情况。结果两组不同时间点的NT-proBNP水平有差异(P<0.05),两组NT-proBNP水平无差异(P>0.05),两组NT-proBNP水平随时间变化趋势有差异(P<0.05);两组不同时间点的血清钠水平有差异(P<0.05),两组血清钠水平无差异(P>0.05),两组血清钠水平随时间变化趋势有差异(P<0.05);两组不同时间点的血尿素氮(BUN)、血肌酐(Scr)、肾小球滤过率(GFR)、β2微球蛋白(β2-MG)、胱抑素C(CysC)水平有差异(P<0.05),两组BUN、Scr、GFR、β2-MG、CysC水平无差异(P>0.05),两组BUN、Scr、GFR、β2-MG、CysC水平随时间变化趋势有差异(P<0.05)。结论托伐普坦能有效改善充血性心力衰竭患者体内的液体潴留,纠正心力衰竭及低钠血症,同时不引起肾功能的恶化,具有肾保护作用。Objective To investigate the clinical efficacy of tolvaptan in patient who have acute congestive heart failure(ACHF)complicated with chronic kidney disease(CKD).Method A total of 98 patients in the Cardiovascular Intensive Care Unit,the First Affiliated Hospital of Zhengzhou University,were enrolled.They were divided into the tolvaptan group(47 cases)and the control group(51 cases)according to whether or not to take tolvaptan.The tolvaptan was treated with tolvaptan additionally at a dose of 7.5 to 15 mg/day,once daily,compared with the control group.The cardiac function,renal function,electrolytes and other indicators were used to be compared between the two groups,before the treatment and 1 week,1 month after the treatment.Renal function worsening was assessed in both groups.Result After 1 week and 1 month of treatment,there were differences in NT-proBNP levels between the two groups at different time points(P<0.05),and there was no difference in the basic NT-proBNP levels between the two groups(P<0.05).The change trend of NT-proBNP levels in the tolvaptan group over time was different from the control group(P<0.05);there were differences in serum sodium levels between the two groups at different time points (P < 0.05), and there was no difference in basal serum sodium levels between thetwo groups (P > 0.05). There was a difference in the changes in serum sodium levels between the two groups overtime (P < 0.05);results of changes in renal function: there were differences in BUN, Scr, GFR, β2 microglobulin andcystatin C levels between the two groups at different time points (P < 0.05);the basic levels of BUN, Scr, GFR, β2microglobulin, and cystatin C were not different between the two groups (P > 0.05);the changes in BUN, Scr, GFR,β2 microglobulin, and cystatin C levels over time between the two groups were different (P < 0.05). ConclusionTolvaptan can effectively improve fluid retention of congestive heart failure, and also can ameliorate heart failure andhyponatremia, meanwhile it doesn't worsen renal funct

关 键 词：充血性心力衰竭 慢性肾功能不全 托伐普坦 

分 类 号：R541.61[医药卫生—心血管疾病]