托伐普坦对不同射血分数慢性心衰患者的临床疗效

Therapeutic effect of tolvaptan on CHF patients with different ejection fraction

目的:探究托伐普坦对不同射血分数慢性心衰(CHF)患者的临床疗效。方法:240例CHF患者根据左室射血分数(LVEF)不同分为射血分数下降组(HFrEF组,120例)和射血分数保留组(HFpEF组,120例),每组根据用药不同再分为常规治疗组(60例)和托伐普坦组(60例,常规治疗组基础上加用托伐普坦)。1个月后比较4组患者的临床疗效和用药安全性。结果:HFrEF组中,与治疗前比较,治疗后两亚组的LVEF、24h尿量、血钠水平均显著提高,左室舒张末期内径(LVEDd)、血肌酐(SCr)、血浆N末端脑钠肽前体(NT-proBNP)水平均显著降低(P均=0.001);且与常规治疗组比较,治疗后托伐普坦组的LVEF[(39.8±5.9)%比(46.7±6.5)%]、24h尿量[(2349.45±310.46)ml比(3104.34±401.35)ml]、血钠[(130.31±7.56)mmol/L比(138.20±8.03)mmol/L]水平及治疗的总有效率(83.3%比95.0%)均显著提高,LVEDd[(54.8±5.1)mm比(48.6±4.9)mm]、血浆NT-proBNP[(4169.47±1022.32)ng/ml比(3774.58±968.36)ng/ml]水平均显著降低,P<0.05或<0.01。HFpEF组中,与治疗前比较,治疗后两亚组的LVEF、24h尿量均显著提高,LVEDd、SCr和NT-proBNP水平均显著降低(P均=0.001);治疗后两组的各项指标无显著差异(P均>0.05)。结论:托伐普坦对不同LVEF的CHF患者均有疗效,可显著改善尿量、心功能,同时用药安全性好,而且对于HFrEF患者效果显著优于常规治疗,值得推广。

Objective:To explore therapeutic effect of tolvaptan on CHF patients with different ejection fraction.Methods:According to LVEF,a total of 240 CHF patients were divided into heart failure with reduced ejection fraction(HFrEF)group(n=120)and heart failure with preserved ejection fraction(HFpEF)group(n=120),each group was further divided into routine treatment group(n=60)and tolvaptan group(n=60,received tolvaptan based on routine treatment group)according to medication.After one month,therapeutic effect and medication safety were compared among the four groups.Results:HFrEF group:compared with before treatment,after treatment,there were significant rise in LVEF,24h urine volume and blood sodium level,and significant reductions in left ventricular end-diastolic dimension(LVEDd),levels of serum creatinine(SCr)and plasma N terminal pro brain natriuretic peptide(NT-proBNP)in two subgroups,P=0.001 all;compared with routine treatment group after treatment,there were significant rise in LVEF[(39.8±5.9)%vs.(46.7±6.5)%],24h urine volume[(2349.45±310.46)ml vs.(3104.34±401.35)ml],blood sodium level[(130.31±7.56)mmol/L vs.(138.20±8.03)mmol/L]and total effective rate(83.3%vs.95.0%),and significant reductions in LVEDd[(54.8±5.1)mm vs.(48.6±4.9)mm]and plasma NT-proBNP level[(4169.47±1022.32)ng/ml vs.(3774.58±968.36)ng/ml]in tolvaptan group,P<0.05 or<0.01.HFpEF group:compared with before treatment,after treatment,there were significant rise in LVEF and 24h urine volume,and significant reductions in LVEDd,levels of SCr and NT-proBNP in two subgroups,P=0.001 all;but there were no significant difference in above indexes between two groups after treatment,P>0.05 all.Conclusion:Tolvaptan possesses significant therapeutic effect on CHF patients with different LVEF,It can significantly improve urine volume and cardiac function with good safety,moreover its effect is significantly superior to routine treatment,which is worth extending.