摘要
目的 观察血管升压素受体拮抗剂托伐普坦对肝硬化失代偿期患者稀释性低钠血症的疗效和安全性.方法 采用双盲法将96例失代偿性肝硬化稀释性低钠血症患者随机分为治疗组56例和对照组40例.治疗组给予常规治疗（保肝、降酶）加单次口服托伐普坦15 mg治疗;对照组给予常规治疗加口服安慰剂治疗.观察两组患者血Na＋浓度、肝功能、腹水和下肢水肿情况.计量资料比较采用t检验,计数资料比较采用x2检验.结果 治疗组第7天36例患者血清Na＋浓度达到正常,占64.3％;对照组9例达到正常,占22.5％,两组比较差异有统计学意义（x2=5.241,P＜0.01）.治疗组56例患者24 h总尿量均超过3500 mL,对照组仅3例24 h总尿量超过3500 mL;两组治疗7d期间24 h尿量比较,差异有统计学意义（t=20.899,P＜0.01）.治疗组腹水减少39例,与对照组腹水减少15例相比,差异有统计学意义（x2=4.260,P=0.039）;而下肢水肿的改善治疗组12例与对照组7例相比,差异无统计学意义（x2 =0.227,P=0.634）.治疗组患者治疗前后ALT、TBil、血K＋和Cr均有改善,但差异无统计学意义（t=1.509、0.783、1.107和1.237,均P＞0.05）,与对照组相比,差异亦无统计学意义（t=1.712、1.635、1.121和0.873,均P＞0.05）.结论 单剂口服托伐普坦有较强的利尿作用,能够提高血清Na＋浓度,对低钠血症患者有明显疗效.
Objective To investigate the efficacy and safety of vasopressin receptor antagonist tolvaptan for treating dilutional hyponatremia casused by decompensated liver cirrhosis.Methods Ninety-six subjects with decompensated liver cirrhosis complicated by dilutional hyponatremia were divided into test group （n =56） and control group （n =40） by double blind method.Test group were treated with a single dose of tolvaptan 15 mg orally in addition to routine therapy,while control group were treated with routine therapy plus placebo.The changes in serum sodium concentration,liver functions,ascites,and edema of lower extremities between the two groups were observed.Measurement data were compared by t test,and categorical data were compared by chisquare test.Results On day 7,36 （64.3%） patients in test group and 9 （22.5%） patients in control group reached normal serum sodium concentrations （x2 =5.241,P〈0.01）.All the patients in test group and only 3 patients in control group had 24 hours＇ total urine volume above 3500 mL.Difference of 24 hours＇ total urine volume during 7-day treatment between the two groups was statistically significant （t=20.899,P〈0.01）.Thirty-nine patients in test group and 15 patients in control group had reduced ascites （x2 =4.260,P=0.039）,but improvement of edema in lower extremities of both groups was comparable （12 cases in test group and 7 cases in control group; x2 =0.227,P=0.634）.Serum alanine aminotransferase （ALT）,total bilirubin （TBil）,potassium and creatinine levels of test group were improved after treatment,but were not significantly different from either baseline levels （t=1.509,0.783,1.107,1.237; both P〉0.05） or those of the control group （t=1.712,1.635,1.121,0.873; both P〉0.05）.Conclusions Single dose of tolvaptan （15 mg） exerts a strong diuretic effect and is able to greatly increase serum sodium concentration,thus has distinct therapeutic effect for patients with decompensated liver cirrhosis complicated by dilutional hyponatremia.
出处
《中华传染病杂志》
CAS
CSCD
北大核心
2013年第11期658-662,共5页
Chinese Journal of Infectious Diseases
关键词
利尿药
肝硬化
低钠血症
Diuretics
Liver cirrhosis
Hyponatremia
