托伐普坦联合腹水超滤浓缩回输术治疗肝硬化并发顽固性腹水患者疗效初步研究*

doi:10.3969/j.issn.1672-5069.2023.03.024

摘要/Abstract

摘要： 目的探讨采用托伐普坦联合腹水超滤浓缩回输术治疗肝硬化并发顽固性腹水(RA)患者的临床效果。方法 2019年9月～2022年9月我院收治的肝硬化并发RA患者93例,采用随机数字表法将患者分为对照组(n=46)和观察组(n=47),分别接受腹水超滤浓缩回输术治疗或在此基础上联合应用托伐普坦片治疗7 d。使用全自动生化分析仪检测血清尿素氮(BUN)、血肌酐(sCr)和电解质,使用超声诊断仪测量门静脉内径(DPV)、脾静脉内径(DSV)、门静脉血流量(PVF)、脾静脉血流量(SVF)和腹水深度。结果在治疗7 d末,观察组24 h尿量为(1957.5±50.3)mL,显著多于对照组【(1316.2±49.1)mL,P<0.05】,而体质量为(58.1±7.2)kg、腹围为(80.6±4.7)cm和腹水深度为(16.5±4.2)mm,均显著低于对照组【分别为(65.4±7.8)kg、(88.1±4.5)cm和(42.7±5.3)mm,P<0.05】;观察组血清BUN和sCr水平分别为(6.2±1.4)mmol/L和(114.2±9.7)μmol/L,显著低于对照组【分别为(6.9±1.6)mmol/L和(129.4±10.3)μmol/L,P<0.05】,而两组肝功能指标比较,差异无统计学意义(P>0.05);观察组血钠为(144.3±1.1)mmol/L,显著高于对照组【(138.1±1.0)mmol/L,P<0.05】;观察组PVF为(994.3±195.7)mL/min,显著低于对照组【(1175.2±210.6)mL/min,P<0.05】,而两组DPV、DSV和SVF比较,差异无统计学意义(P>0.05)。结论在进行腹水超滤浓缩回输术治疗肝硬化并发RA患者时,联合应用托伐普坦口服,可帮助消退腹水,提高尿量,升高血钠水平,短期疗效满意。

关键词: 肝硬化, 顽固性腹水, 托伐普坦, 腹水超滤浓缩回输术, 治疗

Abstract: Objective The aim of this study was to investigate the clinical efficacy of tolvaptan and concentrated ascites reinfusion (CAR) in the treatment of patients with liver cirrhosis-induced refractory ascites (RA). Methods 93 patients with liver cirrhosis-induced RA were encountered in our hospital between September 2019 and September 2022, and were randomly divided into control (n=46) and observation group (n=47), receiving CAR or oral tolvaptan after CAR. The observation lasted for 7 days. Blood urea nitrogen (BUN), serum creatinine (sCr) and serum sodium levels were detected by fully automatic biochemical analyzer. The diameter of portal vein (DPV), diameter of splenic vein (DSV), portal vein flow (PVF) and splenic vein flow (SVF) were measured by ultrasonography. Results At treatment day 7, the 24-hour urine volume in the observation group was (1957.5±50.3) mL, significantly greater than [(1316.2±49.1) mL, P<0.05] in the control group, and the body weight, abdominal circumference and ascites depth were (58.1±7.2)kg, (80.6±4.7)cm and (16.5±4.2)mm, all significantly less than [(65.4±7.8)kg, (88.1±4.5)cm and (42.7±5.3)mm, respectively, P<0.05] in the control; serum BUN and sCr levels in the observation group were (6.2±1.4)mmol/L and (114.2±9.7)μmol/L, much lower than [(6.9±1.6)mmol/L and (129.4±10.3)μmol/L, P<0.05] in the control, while there were no significant differences respect to liver function tests between the two groups (P>0.05); serum sodium level was (144.3±1.1)mmol/L, much higher than [(138.1±1.0)mmol/L, P<0.05] in the control; the PVF was (994.3±195.7)mL/min, much lower than [(1175.2±210.6) mL/min, P<0.05] in the control, while there were no significant differences respect to DPV, DSV and SVF between the two groups (P>0.05). Conclusion The oral administered tolvaptan at base of CAR in dealing with patients with liver cirrhosis-induced RA could help subside ascites, improve the renal function tests and serum sodium levels, and warrants further clinical observation.

Key words: Liver cirrhosis, Refractory ascites, Tolvaptan, Concentrated ascites reinfusion, Therapy

刘坤, 徐菁, 马竹芳. 托伐普坦联合腹水超滤浓缩回输术治疗肝硬化并发顽固性腹水患者疗效初步研究^*[J]. 实用肝脏病杂志, 2023, 26(3): 396-399.

Liu Kun, Xu Jing, Ma Zhufang. Transient improvement of patients with liver cirrhosis-induced refractory ascites by oral tolvaptan administration at base of concentrated ascites reinfusion[J]. Journal of Practical Hepatology, 2023, 26(3): 396-399.

参考文献

[1] Zuo L, Lyu Y, Wang Q, et al. Early-recurrent overt hepatic encephalopathy is associated with reduced survival in cirrhotic patients after transjugular intrahepatic portosystemic shunt creation. J Vasc Interv Radiol, 2019,30(2):148-153.
[2] 徐京杭,樊亚楠,纪童童,等.500例肝硬化住院患者临床特征:一项来自北京某三甲医院的回顾性分析.中华肝脏病杂志,2022,30(5):541-545.
[3] Biggins SW, Angeli P, Garcia-Tsao G,et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American association for the study of liver diseases. Hepatology, 2021,74(2):1014-1048.
[4] 詹惠珍,杜雅钦,王松姣.特利加压素联合腹水浓缩回输术治疗肝硬化并发顽固性腹水患者效果研究.实用肝脏病杂志,2022,25(3):395-398.
[5] Baiges A, Hernández-Gea V. Management of liver decompensation in advanced chronic liver disease: ascites, hyponatremia, and gastroesophageal variceal bleeding. Clin Drug Investig, 2022,42(Suppl 1):25-31.
[6] Estilo A, McCormick L, Rahman M. Using tolvaptan to treat hyponatremia: results from a post-authorization pharmacovigilance study. Adv Ther, 2021,38(12):5721-5736.
[7] 中华医学会肝病学分会.肝硬化腹水及相关并发症的诊疗指南.实用肝脏病杂志,2018,21(1):21-31.
[8] Kimer N, Riedel AN, Hobolth L,et al. Tunneled peritoneal catheter for refractory ascites in cirrhosis: a randomized case-series. Medicina (Kaunas), 2020,56(11):565.
[9] Lyu XY, Ding HG, Zheng JF, et al. Rifaximin improves survival in cirrhotic patients with refractory ascites: A real-world study. World J Gastroenterol, 2020,26(2):199-218.
[10] Neong SF, Adebayo D, Wong F. An update on the pathogenesis and clinical management of cirrhosis with refractory ascites. Expert Rev Gastroenterol Hepatol, 2019,13(4):293-305.
[11] O'Leary JG, Rajender Reddy K, Tandon P,et al. Increased risk of ACLF and inpatient mortality in hospitalized patients with cirrhosis and hepatic hydrothorax. Dig Dis Sci, 2021,66(10):3612-3618.
[12] Garbuzenko DV, Arefyev NO. Current approaches to the management of patients with cirrhotic ascites. World J Gastroenterol, 2019,25(28):3738-3752.
[13] 陈照林,董静,宋海燕,等.特利加压素联合腹水浓缩回输术治疗肝硬化并发顽固性腹水患者临床研究.实用肝脏病杂志,2020,23(4):556-559.
[14] Uojima H, Hidaka H, Tanaka Y, et al. Furosemide dose changes associated with furosemide/tolvaptan combination therapy in patients with cirrhosis. Dig Dis, 2020,38(1):38-45.
[15] Hiramine Y, Uto H, Mawatari S,et al. Effect of tolvaptan on the prognosis of patients with hepatic ascites. Hepatol Res, 2019,49(7):765-777.
[16] Iwamoto T, Maeda M, Saeki I,et al. Analysis of tolvaptan non-responders and outcomes of tolvaptan treatment of ascites. J Gastroenterol Hepatol, 2019,34(7):1231-1235.
[17] Hosui A, Tanimoto T, Okahara T,et al. Early administration of tolvaptan can improve survival in patients with cirrhotic ascites. J Clin Med, 2021,10(2):294.
[18] Sakaida I, Terai S, Kurosaki M,et al. Real-world effectiveness and safety of tolvaptan in liver cirrhosis patients with hepatic edema: results from a post-marketing surveillance study (START study). J Gastroenterol, 2020,55(8):800-810.
[19] Wang S, Zhang X, Han T,et al. Tolvaptan treatment improves survival of cirrhotic patients with ascites and hyponatremia. BMC Gastroenterol, 2018,18(1):137.
[20] Nakano Y, Mizuno T, Niwa T, et al. Impact of continuous administration of tolvaptan on preventing medium-term worsening renal function and long-term adverse events in heart failure patients with chronic kidney disease. Int Heart J, 2018,59(1):105-111.
[21] Kanayama K,Chiba T, Kobayashi K, et al. Long-term administration of tolvaptan to patients with decompensated cirrhosis. Int J Med Sci, 2020,17(7):874-880.
[22] Kida Y. Positive response to tolvaptan treatment would be a good prognostic factor for cirrhotic patients with ascites. Dig Dis, 2019,37(3):239-246.
[23] Li X, Liu S, Xu H,et al. Curative effect and safety of tolvaptan combined with traditional diuretics in treatment of patients with cirrhotic ascites and relevant research on its dose. Am J Ther, 2021,4(1):2-4.

托伐普坦联合腹水超滤浓缩回输术治疗肝硬化并发顽固性腹水患者疗效初步研究^*

Transient improvement of patients with liver cirrhosis-induced refractory ascites by oral tolvaptan administration at base of concentrated ascites reinfusion

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	张绍全, 林炳亮. 肠道菌群与肝硬化研究进展^*[J]. 实用肝脏病杂志, 2023, 26(3): 313-316.
[2]	张丹蕾, 徐静. 艾米替诺福韦治疗慢性乙型肝炎患者早期疗效研究^*[J]. 实用肝脏病杂志, 2023, 26(3): 336-339.
[3]	郭晓玲, 张耀武, 李梦桃, 张辉. 恩替卡韦联合肝爽颗粒治疗慢性乙型肝炎患者疗效研究^*[J]. 实用肝脏病杂志, 2023, 26(3): 340-343.
[4]	王云云, 吴万锋, 李黎. 直接抗病毒药物治疗基因1b型慢性丙型肝炎合并2型糖尿病患者疗效及对血糖控制的影响^*[J]. 实用肝脏病杂志, 2023, 26(3): 344-347.
[5]	许海苗, 郑瑞琦, 丁惠国. 匹伐他汀联合多烯磷脂酰胆碱治疗非酒精性脂肪性肝炎患者疗效研究^*[J]. 实用肝脏病杂志, 2023, 26(3): 352-355.
[6]	郭银燕, 岳枝, 盖晓冬, 冯艳红, 张杰东. 自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征患者临床和肝组织病理学特征分析^*[J]. 实用肝脏病杂志, 2023, 26(3): 372-375.
[7]	何学元, 马建勋, 杨屹立, 张敏, 潘新民. 布地奈德治疗熊去氧胆酸治疗不应答的原发性胆汁性胆管炎患者疗效及血清氧化应激指标的变化^*[J]. 实用肝脏病杂志, 2023, 26(3): 376-379.
[8]	王俊红, 戴玲, 陈国斌, 杨路平, 周晶. 还原型谷胱甘肽、甘草酸二铵和复方甘草酸苷治疗抗结核药物所致药物性肝损伤患者成本-效益分析^*[J]. 实用肝脏病杂志, 2023, 26(3): 380-383.
[9]	卫栋萍, 韩黎黎, 凌佳慧, 顾晓琴, 曹永峰. 甘草酸二胺与复方甘草酸苷治疗环磷酰胺所致的药物性肝损伤患者疗效研究^*[J]. 实用肝脏病杂志, 2023, 26(3): 388-391.
[10]	叶丝陶, 黄晓铨, 陈世耀. 血浆纤维蛋白原水平预测乙型肝炎肝硬化患者内镜治疗后食管胃静脉曲张再出血风险效能分析^*[J]. 实用肝脏病杂志, 2023, 26(3): 392-395.
[11]	刘玲玉, 王韦, 汤佳美. 超声三维斑点追踪技术早期诊断失代偿期肝硬化患者心肌损害应用价值分析^*[J]. 实用肝脏病杂志, 2023, 26(3): 400-403.
[12]	林永祝, 史红媛, 穆西虎. 双源CT肝动脉三期扫描和增强灌注扫描诊断肝硬化背景下小原发性肝癌价值研究^*[J]. 实用肝脏病杂志, 2023, 26(3): 412-415.
[13]	唐亮, 陈曦, 王文高, 董超. TACE联合直线加速器三维适形放疗治疗中晚期原发性肝癌患者近期临床疗效研究[J]. 实用肝脏病杂志, 2023, 26(3): 416-419.
[14]	张威, 陈国林, 王航, 余良, 孔祥璐. 合并不同基础疾病的细菌性肝脓肿患者临床特征分析[J]. 实用肝脏病杂志, 2023, 26(3): 424-427.
[15]	张琼, 陈士颖, 夏维. 超声引导下无水乙醇与聚桂醇硬化治疗单纯性肝囊肿患者效果比较研究^*[J]. 实用肝脏病杂志, 2023, 26(3): 428-431.