托伐普坦在急性射血分数降低心衰合并肾功能不全患者中的观察

程爱媛; 朱存军; 刘丽媛; 贺媛; 王欢; 夏陈海; 林琦; 苏涛

doi:10.12125/j.chj.202207058

托伐普坦在急性射血分数降低心衰合并肾功能不全患者中的观察

Efficacy observation of tolvaptan in patients with acute reduced ejection fraction heart failure combined with renal dysfunction

摘要

摘要:
目的观察托伐普坦对急性射血分数降低心衰合并肾功能不全患者的疗效。
方法入选空军军医大学第一附属医院心血管内科监护室急性心衰合并肾功能不全eGFR（15～60）mL/（min·1.73m²）患者60例，随机分为托伐普坦组与对照组，两组均为30例。托伐普坦组在常规治疗急性心衰基础上加用托伐普坦，对照组给予常规纠正急性心衰治疗。观察两组48 h尿量、袢利尿剂使用剂量、呼吸困难、双下肢水肿改善程度、血Cr、BUN、eGFR、BNP指标变化、不良事件发生率（低钠血症、高钠血症、低钾血症等）以及两组90 d再住院率和死亡率。
结果与对照组相比，托伐普坦组主要终点（48 h 尿量）显著增加（6 506 ± 454）mL vs.（4 630 ± 273）mL, P<0.01）。次要终点中，托伐普坦组 48 h 袢利尿剂总量比对照组低（102 ± 15） mg vs.（166 ± 19）mg，P<0.01）。水肿、呼吸困难等指标托伐普坦组与对照组均显著改善，均P<0.01，但两组相比无统计学差异。两组Cr、BUN值均呈下降趋势，托伐普坦组肌酐（Cr）、尿素（BUN）值下降更明显，托伐普坦组eGFR值上升更明显，均P<0.01。托伐普坦组与对照组低钠、低钾不良事件发生率为3% vs. 10%， P<0.05。随访90 d，两组再住院率及病死率为13% vs. 17%，无统计学差异。
结论托伐普坦可使伴有肾功能不全的急性心衰患者尿量增加，呼吸困难、双下肢水肿等淤血症状改善，提升血钠水平，减少肾功能损伤。

Abstract:
AIM To observe the efficacy of tolvaptan in patients with acute ejection fraction-reduced heart failure complicated with renal dysfunction.
METHODS A total of 60 patients with acute heart failure and renal dysfunction eGFR(15～60) mL/（min·1.73m²） in the Cardiovascular Intensive Care Unit of the First Affiliated Hospital of Air Force Medical University were divided into two groups. Conventional treatment of acute heart failure was applied in control group and Tovaptan was added to conventional treatment of acute heart failure in experimental group. Forty-eight-hour urine output, dosage of loop diuretics, improvement of dyspnea, edema of both lower extremities and the changes of Cr, BUN, eGFR and NT-proBNP were observed in both groups.
RESULTS Compared with the control group, the primary end point (48h urine volume) in the tolvaptan group was significantly increased (6 506 ± 454) mL vs. (4 630 ± 273) mL, P<0.01. In the secondary end point, the total amount of loop diuretics in the Tuvaptan group at 48 hours was lower than that in the control group (102 ± 15) mg vs. (166 ± 19) mg, P<0.01). Edema, dyspnea and other indicators were significantly improved in the Tuvastan group and the control group, both P<0.01, but there was no statistical difference between the two groups. Cr and BUN values in the two groups showed a downward trend, creatinine (Cr) and urea (BUN) values in the Tovapram group decreased more significantly, and eGFR values in the Tovapram group increased more significantly, both P<0.01. The incidence of adverse events of low sodium and low potassium in the Tuvaptan group and the control group was 3% vs. 10%, P<0.05. After 90 days of follow-up, the readmission rate and fatality rate of the two groups were 13% vs. 17%, with no statistical difference.
CONCLUSION Tolvaptan can increase urine volume, improve congestion symptoms such as dyspnea and edema of both lower limbs in acute heart failure patients with renal insufficiency, increase blood sodium level and reduce renal function damage.

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