托伐普坦治疗肺癌相关性低钠血症观察

Efficacy and Safety of Tolvaptan in Treatment of Hyponatremia Caused by Lung Cancer

目的:观察托伐普坦治疗肺癌相关性低钠血症患者,对患者血钠、血渗透压、24 h尿量等指标的影响。方法:肺癌合并抗利尿激素分泌不当综合征的低钠血症患者36例随机分为观察组和对照组各18例,观察组给予常规治疗+托伐普坦片,对照组给予常规治疗+安慰剂,治疗7 d后,比较两组患者治疗前后血钠、血渗透压、24 h尿量,以及体重、血压、心率、肝肾功能等指标的变化,观察治疗期间两组药品不良反应发生情况。结果:治疗后对照组及观察组的血钠水平和血渗透压均较治疗前升高(P<0.05),24 h尿量均较治疗前增多(P<0.01);且治疗后观察组血钠水平及血渗透压明显高于对照组(P<0.01),24 h尿量明显高于对照组(P<0.01)。治疗前后两组患者体重,血压及心率的变化均在正常范围内,且两组间差异无统计学意义(P>0.05)。随着托伐普坦剂量的增加,患者血钠浓度增加值逐渐升高。两组患者均未出现严重不良反应,仅观察组3例患者出现口干不适。结论:托伐普坦治疗肺癌合并低钠血症的患者疗效确切,可以改善患者的生存质量,且安全可靠。

Objective：To study the efficacy and safety of tolvaptan on treatment of hyponatremia caused by lung cancer. Methods：36 patients with hyponatremia caused by syndrome of inappropriate antidiuretic hormone secretion （ SI- ADH ） in lung cancer were randomly divided into therapy group （ 18 cases ,conventional treatment ＋ tolvaptan） and control group （18 cases ,conventional treatment ＋ placebo）. After seven days treatment,the clinical effect and safety were com- pared between two groups. Results： After treatment, the blood sodium level and plasma osmotic pressure of the two groups were both higher than before（ P 〈 0.05 ）, 24 hours m＇ine volume were both increased than before （ P 〈 0.01 ） ; and after treatment, the blood sodium level and plasma osmotic pressure of the therapy group were significantly higher than the con- trol group（ P 〈 0.01 ）, 24h urine volume was evidently higher than that of the control group（ P 〈 0.01 ）. The changes of the weight, blood pressure and heart rate were in normal range comparing the groups before treatment with the groups after treatment, meanwhile the difference between two groups represented no statistical significance （ P 〉 0.05 ）. With the in- crease of tolvaptan dose, the blood sodium concentration increased gradually ;There were no severe complication and ad- verse reaction, and only 3 cases of dry mouth were found in therapy group. Conclusion：Tolvaptan had distinct therapeutic effect for patients with hyponatremia caused by lung cancer, and it could improve their qualities of life with good safety relia- bility.