早期使用托伐普坦减低老年急性心力衰竭患者肾功能恶化

Early treatment with tolvaptan reduces worsening renal function in elderly patients with acute heart failure

目的探讨早期使用托伐普坦治疗老年急性心力衰竭(AHF)合并慢性肾功能不全(CKD)患者的有效性和安全性。方法回顾性分析2016年7月至2021年7月住空军特色医学中心(原空军总医院)的102例AHF合并CKD的老年患者资料,并且在住院期间使用托伐普坦超过2 d。按照使用托伐普坦时间的早晚分为入院6 h内使用托伐普坦组(治疗组)与入院48 h后使用托伐普坦组(对照组)。主要观察终点是2组患者住院期间肾功能恶化发生率、全因死亡率及住院时间。结果与对照组比较,入院6 h内使用托伐普坦组患者肾功能恶化发生率更低(4.08%比26.42%,χ^(2)=9.602,P=0.002);全因死亡率更低(8.16%比22.64%,χ^(2)=4.035,P=0.045)。2组患者住院时长或使用托伐普坦剂量差异无统计学意义。结论早期使用托伐普坦治疗AHF合并CKD患者是有效的,能显著减少患者肾功能恶化发生率,降低全因死亡率。

Objective To explore the effectiveness and safety of the early use tolvaptan in elderly patients with acute heart failure(AHF)and chronic kidney disease(CKD).Methods One hundred and two patients with AHF and CKD were treated with tolvaptan at least two days in the Air Force Medical Center,PLA,between July 2016 and July 2021.These were divided into two groups according to the use of tolvaptan within 6 h(treatment group)or after 48 h of hospitalization(control group).The endpoints were the incidence of worsening renal function,death by any cause,or the length of hospital stay.Results Compared with control group,the incidence of worsening renal function(4.08%vs 26.42%,χ^(2)=9.602,P=0.002),death by any cause(8.16%vs.22.64%,χ^(2)=4.035,P=0.045)in control group lowered significantly.There were no significant differences between the two groups in mean length of hospital stay or dose of tolvaptan after hospitalization.Conclusions Early treatment with tolvaptan is efficacy and safety in elderly patients with AHF and CKD,which may help less worsening renal function and death by any cause.