托伐普坦治疗顽固性腹水疗效及安全性分析*

doi:10.3969/j.issn.1672-5069.2014.06.016

实用肝脏病杂志 ›› 2014, Vol. 17 ›› Issue (6): 623-628.doi: 10.3969/j.issn.1672-5069.2014.06.016

托伐普坦治疗顽固性腹水疗效及安全性分析^*

郑俊福, 张鑫, 赵文敏, 李鹏, 范春蕾, 李冰, 李磊, 董培玲, 丁惠国

100069 北京市首都医科大学附属北京佑安医院消化中心

出版日期:2014-12-31 发布日期:2016-04-11
通讯作者: 丁惠国,E-mail:dinghuiguo@medmail.com.cn
作者简介:郑俊福,男,35岁,硕士研究生,主治医师。主要从事传染病及肝病研究。E-mail:zhengjunfu1979@foxmail.com
基金资助:
北京市卫生系统高层次卫生技术人才培养计划项目（编号：2013-3-072）

Efficacy and safety of tolvaptan in the treatment of patients with refractory ascites

Zheng Junfu, Zhang Xin, Zhao Wenmin

Department of Gastroenterology and Hepatology,Youan Hospital,Capital Medical University, Beijing 100069,China

Online:2014-12-31 Published:2016-04-11

摘要/Abstract

摘要： 目的观察高度选择性血管加压素V2受体拮抗剂托伐普坦治疗顽固性腹水的疗效和安全性。方法在39例终末期肝病（20例肝硬化、19例肝硬化合并肝癌）引起的顽固性腹水患者,常规给予利尿剂（呋塞米80 mg/d;螺内酯160 mg/d）及白蛋白治疗的基础上,给予托伐普坦15 mg/d口服,治疗5~14 d。观察尿量、腹水消退、双下肢水肿改善及血清钠和肝功能变化情况。结果在托伐普坦治疗结束后24 h,患者平均尿量为（3533.3±154.65）ml/d,明显高于治疗前（1851.3±167.12） ml/d（P<0.01）;82.5%（32/39）患者腹水改善,2例I型肝肾综合征患者对托伐普坦治疗无明显效果;在21例低钠血症患者中,血清钠较治疗前[（128.1±4.25） mmol/L]明显上升[（132.9±4.1） mmol/l,P<0.01];治疗前后患者MELD评分[（37.5±5.6）对（38.1±5.7）]、血钾水平[（4.1±0.5） mmol/L对（4.2±0.6） mmol/L]无明显变化;该药的不良反应以口干、口渴为主,发生率为15.4%。结论托伐普坦对终末期肝病引起的顽固性腹水患者有一定的利尿作用,可同时纠正低钠血症,短期应用托伐普坦对肝功能无明显影响。

关键词: 顽固性腹水, 终末期肝病, 托伐普坦, 低钠血症

Key words: Refractory ascites, End-stage liver diseases, Tolvaptan, Hyponatremia

郑俊福, 张鑫, 赵文敏, 李鹏, 范春蕾, 李冰, 李磊, 董培玲, 丁惠国. 托伐普坦治疗顽固性腹水疗效及安全性分析^*[J]. 实用肝脏病杂志, 2014, 17(6): 623-628.

Zheng Junfu, Zhang Xin, Zhao Wenmin. Efficacy and safety of tolvaptan in the treatment of patients with refractory ascites[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2014, 17(6): 623-628.

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托伐普坦治疗顽固性腹水疗效及安全性分析^*

Efficacy and safety of tolvaptan in the treatment of patients with refractory ascites

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