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托伐普坦治疗射血分数保留型心力衰竭合并低钠血症的临床观察
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| 篇名： | 托伐普坦治疗射血分数保留型心力衰竭合并低钠血症的临床观察 |
| TITLE： | Clinical observation of tolvaptan in the treatment of heart failure with preserved ejection fraction complicated with hyponatremia |
| 摘要： | 目的 探讨托伐普坦治疗射血分数保留型心力衰竭（HFpEF）合并低钠血症的疗效和安全性。方法选择2020年1月1日－2023年6月1日南阳医学高等专科学校第一附属医院心内科收治的HFpEF合并有低钠血症患者106例，根据随机数字表法分为常规治疗组（53例）和托伐普坦组（53例）。常规治疗组患者给予常规治疗；托伐普坦组患者在常规治疗组的基础上给予托伐普坦片15mg，24h后增至30mg，然后根据血清钠水平增减剂量，最大剂量不超过60mg/d，血清钠水平≥150mmol/L时停药。两组患者均治疗6个月。比较两组患者治疗前后的心功能指标[左室射血分数（LVEF）、左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）、氨基末端脑利钠肽前体（NT-proBNP）]、24h尿量、血清钠、血肌酐、尿素氮水平及其变化幅度，并记录不良反应发生情况。结果治疗前，两组患者各指标组间比较，差异均无统计学意义（P＞0.05）。治疗后，两组患者的LVEF、24h尿量、血清钠水平均显著高于同组治疗前，且托伐普坦组显著高于常规治疗组；LVESD、LVEDD、NT-proBNP均显著低于同组治疗前，且托伐普坦组显著低于常规治疗组（P＜0.05或P＜0.01）。托伐普坦组患者的心功能指标、24h尿量、血清钠水平的变化均较常规治疗组更明显（P＜0.05）。两组患者治疗前后的血肌酐、尿素氮水平及变化幅度，以及恶心呕吐、头晕、高钠血症、尿频的发生率比较，差异均无统计学意义（P＞0.05）。结论托伐普坦能够改善HFpEF合并低钠血症患者的心功能，增加血钠水平，且不影响其肾功能，不增加不良反应的发生风险。 |
| ABSTRACT： | OBJECTIVE To explore the therapeutic effect and safety of tolvaptan in the treatment of heart failure with preserved ejection fraction （HFpEF） complicated with hyponatremia. METHODS Overall 106 patients with HFpEF complicated with hyponatremia were collected from the Department of Cardiology in the First Affiliated Hospital of Nanyang Medical College from January 1， 2020 to June 1， 2023. According to the random number table， the patients were divided into conventional treatment group （n＝53） and tolvaptan group （n＝53）. The conventional treatment group was given conventional treatment. Tolvaptan group additionally received Tolvaptan tablets 15 mg on the basis of conventional treatment group， increasing to 30 mg after 24 h， and then adjusting the dosage according to the levels of serum sodium； the maximum dose should not exceed 60 mg/d， and the medication should be stopped when the serum sodium level was≥150 mmol/L. Both groups of patients were treated for 6 months. The levels and changes of cardiac function indexes [left ventricular ejection fraction （LVEF）， left ventricular end systolic diameter （LVESD）， left ventricular end diastolic diameter （LVEDD）， N-terminal pro-brain natriuretic peptide （NT-proBNP）]， 24 h urine output， serum sodium， blood creatinine and urea nitrogen were compared between 2 groups before and after treatment. The occurrence of adverse drug reaction （ADR） was recorded. RESULTS Before treatment， there was no statistically significant difference in those indexes between 2 groups （P＞0.05）. After treatment， the levels of LVEF， 24 h urine output and serum sodium in 2 groups were significantly higher than before treatment， and the tolvaptan group was significantly higher than the conventional treatment group； the levels of LVESD， LVEDD and NT-proBNP were significantly lower than before treatment， and the tolvaptan group was significantly lower than the conventional treatment group （P＜0.05 or P＜0.01）. The changes in cardiac function indexes， 24 h urine output and serum sodium levels in the atorvastatin group were more significant than the conventional treatment group （P＜0.05）. There was no statistically significant difference in the levels and changes of blood creatinine and urea nitrogen before and after treatment， as well as the incidence of nausea and vomiting， dizziness， hypernatremia and frequent urination between 2 groups （P＞0.05）. CONCLUSIONS Tolvaptan can improve cardiac function and increase the blood sodium levels in patients with HFpEF complicated with hyponatremia， without affecting their renal function or increasing the risk of ADR. |
| 期刊： | 2024年第35卷第18期 |
| 作者： | 穆清；李志英；张景迪；张占海；宋卫锋 |
| AUTHORS： | MU Qing，LI Zhiying，ZHANG Jingdi，ZHANG Zhanhai，SONG Weifeng |
| 关键字： | 托伐普坦；射血分数保留型心力衰竭；低钠血症；心功能 |
| KEYWORDS： | tolvaptan； heart failure with preserved ejection fraction； hyponatremia； cardiac function |
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