托伐普坦治疗中枢神经系统疾病导致SIADH的疗效分析

Treatment effect of tolvaptan on central neurogenic syndrome of inappropriate antidiuretic hormone secretion

目的探讨血管加压素-2受体拮抗剂托伐普坦治疗中枢神经系统疾病导致抗利尿激素分泌异常综合征（SIADH）患者的疗效。方法本研究前瞻性纳入河南省人民医院神经外科2013年3月至2015年1月收治的56例伴发SIADH患者，采用随机数字表完全随机分组的方法，将患者分为托伐普坦治疗组（28例）和传统治疗组（28例）。比较两组患者治疗后血清钠升高值、治疗时间及不良事件的发生率，以评估托伐普坦的有效性和安全性。结果治疗72 h、96 h后，托伐普坦治疗组的患者血清钠升高值[分别为（15.38±2.45）mmol/L、（16.75±2.89）mmol/L]均明显高于传统治疗组[分别为（10.89±1.91）mmol/L、（14.39±2.45）mmol/L，P〈0.05]；血清钠纠正至正常水平所需的治疗时间，托伐普坦治疗组（72 h）较传统治疗组（120 h）明显缩短（P〈0.05）；不良事件的发生率托伐普坦治疗组与传统治疗组比较差异无统计学意义（P〉0.05）。结论托伐普坦可在较短时间内有效纠正SIADH所致的低钠血症；且不受液体入量的限制，适用范围广，不良事件发生率较低。

Objective To investigate the treatment effect of tolvaptan （vasopressin-2 receptor antagonist） on central neurogenic syndrome of inappropriate antidiuretic hormone secretion （SIADH）. Methods A total of 56 patients with SIADH were admitted to Department of Neurosurgery, Henan Provincial People＇s Hospital from March 2013 to January 2015 and enrolled in this study. By using a random number table, all cases were divided into 2 groups including tolvaptan group （n = 28） and conventional treatment group （n = 28）. In order to assess the efficacy and safety of tolvaptan, the increased level of plasma sodium following treatment, medication time and rate of adverse events were compared with the 2 groups. Results At 72 h and 96 h post treatment, the increased levels of plasma sodium in tolvaptan group （15.38± 2.45 mmol/L, 16.75± 2.89 mmol/ L） were both significantly higher than those in conventional group （ 10. 89 ±1.91 mmol/L, 14.39 ±2.45 mmol/ L） （P 〈0.05）. The medication period before plasma sodium level recovered to normal in tolvaptan group （72 h） was significantly shorter than that in conventional group （120 h） （P 〈0. 05）. And the incidence rate of adverse events was similar between the 2 groups （ P 〉 0. 05 ）. Conclusion Tolvaptan seems to be able to correct SIADH-induced hyponatremia in relatively short time with little limits of fluid intake, wide range of application and low incidence of adverse events.