托伐普坦治疗超高龄射血分数保留型心力衰竭合并轻中度低钠血症患者临床疗效

Clinical efficacy of tolvaptan in the treatment of ultra-elderly patients with heart failure with preserved ejection fraction complicated with mild to moderate hyponatremia

目的 探讨托伐普坦治疗超高龄射血分数保留型心力衰竭(HFpEF)合并轻中度低钠血症患者的临床疗效。方法 选取自2019年10月至2022年10月北部战区总医院收治的194例超高龄HFpEF合并轻中度低钠血症患者为研究对象。采用随机数字表法将患者分为A组与B组,每组各97例。两组均接受常规抗心力衰竭治疗。A组采用呋塞米联合口服补钠治疗;B组采用托伐普坦治疗。比较两组患者治疗前、治疗后4 d、治疗后7 d的血压、24 h尿量、体质量、血钠(Na^(+))、血钾(K^(+))、血清丙氨酸氨基转移酶(ALT)、血清天门冬氨酸氨基转移酶(AST)、尿素氮(BUN)、血清肌酐(Scr)、N末端B型脑钠肽前体(NT-proBNP)。比较两组患者治疗前及治疗后7 d的左室射血分数(LVEF)。比较两组患者临床治疗的总有效率及不良反应发生情况。结果 B组治疗后4 d、治疗后7 d的Na^(+)、24 h尿量均高于A组,差异均有统计学意义(P<0.05)。患者治疗前、治疗后4 d、治疗后7 d的体质量、收缩压、舒张压、K^(+)、ALT、AST、BUN、Scr比较,差异均无统计学意义(P>0.05)。B组治疗后4 d、治疗后7 d的NT-proBNP低于A组,差异均有统计学意义(P<0.05)。B组临床治疗总有效率为82.5%(80/97),高于A组的68.0%(66/97),差异有统计学意义(P<0.05)。B组6个月内因心力衰竭再住院率为11.3%(11/97),与A组的23.7%(23/97)比较,差异有统计学意义(P<0.05)。结论 托伐普坦可纠正HFpEF合并轻中度低钠血症患者Na+水平,改善心功能,降低心力衰竭再住院率,疗效显著,安全性较高。

Objective To investigate the clinical efficacy of tolvaptan in the treatment of ultra-elderly patients with heart failure with preserved ejection fraction(HFpEF)complicated with mild to moderate hyponatremia.Methods A total of 194 ultra-old HFpEF patients with mild to moderate hyponatremia admitted to General Hospital of Northern Theater Command from October 2019 to October 2022 were selected as the study objects.The patients were divided into group A and group B with 97 cases in each group by random number table.Both groups received conventional anti-heart failure therapy.Group A was treated with furosemide combined with oral sodium supplementation.Group B was treated with tolvaptan.The blood pressure,24 hours urine volume,body mass,blood sodium(Na^(+)),blood potassium(K^(+)),serum alanine aminotransferase(ALT),serum aspartate aminotransferase(AST),urea nitrogen(BUN),serum creatinine(Scr),N-terminal B-type brain natriuretic peptide precursor(NT-proBNP)of the two groups were compared before treatment,4 days after treatment and 7 days after treatment.The left ventricular ejection fraction(LVEF)of the two groups were compared before treatment and 7 days after treatment.The total effective rate and the occurrence of adverse reactions were compared between the two groups.Results The Na^(+)and 24 hours urine volume of group B at 4 and 7 days after treatment were higher than those of group A,and the differences were statistically significant(P<0.05).There was no significant difference in body mass,systolic blood pressure,diastolic blood pressure,K^(+),ALT,AST,BUN and Scr between two groups before treatment,4 days and 7 days after treatment(P>0.05).The NT-proBNP of group B at 4 and 7 days after treatment was lower than that of group A,and the differences were statistically significant(P<0.05).The total effective rate of group B was 82.5%(80/97),higher than that of group A(68.0%,66/97),and the difference was statistically significant(P<0.05).The rate of re-hospitalization for heart failure within 6 months in group B was 11.3%(11/97),compared with 23.7%(23/97)in group A,the difference was statistically significant(P<0.05).Conclusion Tolvaptan can correct Na^(+)of HFpEF patients with mild to moderate hyponatremia,improve cardiac function,reduce the rate of heart failure rehospitalization,with significant efficacy and high safety.