托伐普坦治疗慢性重度心衰的疗效研究

Effect of tolvaptan on severe chronic heart failure

目的探讨托伐普坦对慢性重度心衰患者的治疗效果,并随访其半年内的死亡率。方法 49例慢性重度心衰患者根据是否使用托伐普坦分为托伐普坦组(观察组,31例)与常规治疗组(对照组,18例)。记录两组患者的生命体征、电解质、每日清晨体重及液体出入量,观察心功能的改善情况。心脏彩色多普勒测定左室舒张末期内径(LVEDD)及左室射血分数(LVEF)。测定血清肾素(PRA)、血管紧张素Ⅱ(PRA)、醛固酮(ALD)、去甲肾上腺素(NE)、血清氮末端脑钠素原(NT-proBNP)水平及抗利尿激素(ADH)水平。随访患者半年内的死亡相关终点事件。结果治疗后,托伐普坦组患者心功能明显改善(P<0.05)。用药24 h内,托伐普坦组患者尿量明显增加,体重迅速降低(P<0.01),血清钠、氯浓度提高(P<0.05)。治疗后,两组LVEDD比较差异无统计学意义(P>0.05),但托伐普坦组的LVEF值高于常规治疗组,差异有统计学意义(P<0.01)。托伐普坦组血清神经内分泌因子水平降低(P<0.05)。随访6个月,两组死亡率比较差异无统计学意义(P>0.05)。结论托伐普坦可迅速改善心功能,纠正低钠低氯血症,抑制神经内分泌因子,且不增加死亡风险。

Objective To explore the effect of tolvaptan on severe chronic heart failure （SCHF） , and follow up the mortality during six months. Methods Forty-nine SCHF patients were divided into 2 groups： tolvaptan group （ n = 31 ） and conventional treatment group （ n = 18 ）. The vital signs, serum electrolyte, daily weight, liquid intake and output were recorded. Left ventricular end diastolic diameter （LVEDD） and left ventricular ejection fraction（LVEF） were measured by color doppler echocardiography. The levels of serum Renin （ PRA）, angiotensin Ⅱ （ Ang Ⅱ ）, aldostetone （ALD）, antidiuretic hormone （ADH）, norepinephrine （NE） and N-terminal pro brain natriuretic peptide （NT- proBNP） were measured. The death related events were followed up for six months. Results After treatment,the heart function in patients of tolvaptan group was improved （ P 〈 0.05 ）. At 24 h after medication, the urine volume of tolvaptan group increased significantly ,the weight reduced （P 〈 0.0l ）, and the serum sodium and chloride concentration increased （ P 〈 0. 05 ）. After treatment, there was no significant difference in LVEDD between the two groups （ P 〉 0.05 ）, but the level of LVEF in tolvaptan group was higher than that of conventional treatment group （ P 〈 0. 01 ）. The levels of serum neuroendocrine factors in tolvaptan group decreased （ P 〈 0. 05 ）. There was no significant difference in death related events between the two groups during the six months of follow up （ P 〉 0. 05 ）. Conclusion Tolvaptan could quickly improve the heart function, attenuate the hyponatremia and hypochloremia, inhibit neuroendocrine factors and do not increase the risk of death.