托伐普坦对左室射血分数降低心衰患者预后的影响

Effects of tolvaptan treatment on prognosis of heart failure patients with reduced left ventricular ejection fraction

目的:比较传统利尿剂联用与不联用托伐普坦在治疗左室射血分数降低的慢性失代偿心衰时的近期和远期疗效,探索托伐普坦对慢性失代偿性心衰患者预后的影响。方法:选择同济大学附属东方医院心内科及上海市浦东新区唐镇社区卫生服务中心2013年2月至2015年5月收治的慢性失代偿期心衰患者115例。所有患者在接受标准抗心衰药物治疗的基础上,根据是否联用托伐普坦,分为标准治疗组(n=68)及托伐普坦组(n=47)。在用药前及用药后1周内记录患者体质量,计算血清渗透压,进行重复测量方差分析;并对所有纳入患者进行为期2年的随访,绘制Kaplan-Meier生存曲线,分析两组患者的心衰再住院率、非致死性心梗发生率、心血管死亡率和全因死亡率,并对可能影响预后的因素进行Cox多因素回归分析。结果:两组患者的基线资料差异无统计学意义。治疗后,托伐普坦组患者的体质量及氨基末端B型脑钠肽前体(N-terminal pro B-type natriuretic peptide,NT-proBNP)低于标准治疗组(P<0.05);托伐普坦组患者的平均住院时间短于标准治疗组(P<0.01),心衰再住院率低于标准治疗组(P<0.05);两组患者的非致死性心梗发生率、心血管死亡率及全因死亡率差异无统计学意义。结论:在进行标准抗心衰药物治疗的基础上,托伐普坦可改善慢性失代偿性心衰患者的临床症状,减少平均住院时间及心衰再住院率,不影响患者的非致死性心梗发生率、心血管死亡率及全因死亡率。

Objective:To compare the short-and long-term efficacies of the traditional diuretics combined with or without tolvaptan for the chronic decompensated heart failure patients with reduced left ventricular ejection fraction,and investigate the effect of tolvaptan on the prognosis of patients with chronic decompensated heart failure.Methods:A total of115patients with chronic decompensated heart failure were selected from the Department of Cardiology,Shanghai East Hospital and Tangzhen Community Health Center,Pudong New Area,Shanghai from February2013to May2015.According to whether tolvaptan was additionally used,115patients were divided into standard treatment group(n=68)and tolvaptan group(n=47).The body weight of patients was recorded before and1week after the treatment,the plasma osmotic pressure was calculated,and the changing trend was analyzed by ANOVA for repeated measurement.All patients were followed up for2years,and Kaplan-Meier survival curve was plotted to analyze the incidence of heart failure readmission,non-fatal myocardial infarction,cardiovascular mortality,and all-cause mortality in the two groups.Cox multivariate regression analysis was used to analyze the prognostic factors.Results:The difference between the two groups in basic information was not statistically significant.After the treatment,the body weight and the level of N-terminal pro B-type natriuretic peptide(NT-proBNP)of patients in tolvaptan group were significantly lower than those in the standard treatment group(P<0.05).The average hospital stay and heart failure readmission in tolvaptan group were lower than those in the standard treatment group(P<0.01,0.05).There was no significant difference in the incidence of non-fatal myocardial infarction,cardiovascular mortality,and all-cause mortality.Conclusions:On the basis of standard anti-heart failure drug therapy,tolvaptan can alleviate the clinical symptoms of patients with chronic decompensated heart failure,and reduce the average hospital stay and heart failure readmission rate.However,tolvaptan may not affect the incidence of non-fatal myocardial infarction,cardiovascular mortality,and all-cause mortality.