Durable response without recurrence to Tolvaptan improves long-term survival
Durable response without recurrence to Tolvaptan improves long-term survival
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托伐普坦的持久缓解且不复发可提高长期生存率
DOI：
10.1007/s00535-020-01721-8
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Sakamoto N.
中科院分区：
文献类型：
--
作者：
Nakai M;Suda G;Kubo A;Tokuchi Y;Kitagataya T;Yamada R;Shigesawa T;Suzuki K;Nakamura A;Kawagishi N;Ohara M;Umemura M;Sho T;Morikawa K;Ogawa K;Sakamoto N.
背景失代偿期肝硬化合并难治性腹水或胸腔积液患者预后较差。托伐普坦已被用于治疗肝硬化相关的水潴留。然而，尽管有短期反应，在某些情况下仍观察到水潴留复发。本研究旨在阐明水潴留复发率及长期无复发与预后的关系。方法回顾性分析100例托伐普坦治疗失代偿期肝硬化患者的临床资料。根据EASL临床实践指南的标准评估复发。分析无应答者、复发患者和长期应答者的复发率和预后。同时评估与短期反应、复发和长期反应相关的基线因素。结果约31.0%的短期缓解者复发。两组患者短期疗效差异无统计学意义（p= 0.07），但长期疗效者预后明显优于复发及无疗效者（p< 0.01）。低CRP水平和高尿Na/K比值是短期反应相关的重要因素，急性肾损伤的存在也是无反应相关的因素。低CRP水平（复发：< 1.10 mg/dl，长期反应：< 0.94 mg/dl）被确定为复发和长期反应相关的因素。结论无复发的长期缓解者预后明显较好。CRP是长期反应的有效预测因子，而肾功能参数是短期反应的有效预测因子。炎症控制可能对肝硬化伴水潴留患者的长期反应和预后很重要。
BackgroundDecompensated liver cirrhosis patients with refractory ascites or pleural effusion have a poor prognosis. Tolvaptan has been used for treating water retention associated with cirrhosis. However, despite the short-term response, water retention recurrence is still observed in some cases. This study aimed to clarify the water retention recurrence rate and the relationship between long-term response without recurrence and prognosis.MethodsAltogether, 100 patients with decompensated cirrhosis treated with tolvaptan were retrospectively analyzed. Recurrence was evaluated according to the criteria of the EASL clinical practice guideline. The recurrence rate and prognosis of non-responders, patients with recurrence, and long-term responders were analyzed. The baseline factors related to short-term response, recurrence, and long-term response were also evaluated.ResultsApproximately 31.0% of the short-term responders had recurrence. Although there was no significant difference in the prognosis by short-term response (p= 0.07), the long-term responders had a significantly better prognosis than those with recurrence and non-responders (p< 0.01). Low CRP levels and high urinary Na/K ratios were significant factors related to short-term response, and the presence of acute kidney injury was also a factor related to non-response. The low CRP level (relapse: < 1.10 mg/dl, long-term response: < 0.94 mg/dl) was identified as a factor related to recurrence and long-term response.ConclusionThe long-term responders without recurrence had a significantly better prognosis. CRP was a useful predictor for long-term response, whereas renal function parameters were useful predictors for short-term response. Inflammation control may be important for long-term response and prognosis in cirrhosis patients with water retention.
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影响因子：
3.2
作者：
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影响因子：
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作者：
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影响因子：
2.3
作者：
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通讯作者：
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