Positive Response to Tolvaptan Treatment Would Be a Good Prognostic Factor for Cirrhotic Patients with Ascites
Positive Response to Tolvaptan Treatment Would Be a Good Prognostic Factor for Cirrhotic Patients with Ascites
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对托伐普坦治疗的积极反应将是肝硬化腹水患者的良好预后因素
DOI：
10.1159/000494438
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发表时间：
2019
影响因子：
2.3
通讯作者：
Y. Kida
中科院分区：
文献类型：
--
作者：
Y. Kida
目的：腹水是晚期腹膜透析患者的主要并发症之一。托伐普坦是一种非肽类口服精氨酸加压素V2受体拮抗剂。我们研究发现，托伐普坦治疗可改善腹水患者的预后和预测因子。方法：共纳入99例新诊断的肝硬化腹水患者。无患者发生肝内恶性肿瘤。根据托伐普坦治疗将患者分为2组：86例接受托伐普坦治疗的患者（托伐普坦组）和13例未接受托伐普坦治疗的患者（非托伐普坦组）。托伐普坦应答者定义为托伐普坦给药后体重减轻≥1.5 kg/周。结果：托伐普坦治疗急性胰腺炎有效率为61.6%。托伐普坦应答组与其他组之间的总生存期（OS）有显著差异（p < 0.001）。男性（人力资源5.05; p = 0.01）、托伐普坦应答者（HR 0.21; p = 0.02）和呋塞米剂量< 40 mg/天（HR 0.17; p = 0.01）是与OS独立相关的因素。p = 0.001）和呋塞米剂量< 40 mg/天（HR 0.09; p = 0.003）与托伐普坦反应独立相关。结论：托伐普坦治疗肝硬化合并腹水患者的疗效与生存期延长相关。这些初步调查结果值得验证和进一步探讨。
Aims: Ascites is one of the major complications in advanced cirrhotic patients. Tolvaptan is a non-peptide orally available arginine vasopressin V2 receptor antagonist. We investigated and found that tolvaptan therapy improved the prognosis and predictive factor of cirrhotic patients with ascites. Methods: Overall, 99 patients with newly diagnosed ascites with cirrhosis were enrolled. No patients had intrahepatic malignancy. The patients were divided into 2 groups based on tolvaptan therapy: 86 patients treated with tolvaptan (tolvaptan-group) and 13 patients treated without tolvaptan (non-tolvaptan-group). Tolvaptan-responder was defined as body weight loss of ≥1.5 kg/week after administering tolvaptan. Results: Tolvaptan therapy was effective in 61.6% of cirrhotic patients. There was a significant difference in the overall survival (OS) between the tolvaptan-responder-group and the other groups (p < 0.001). Male (HR 5.05; p = 0.01), tolvaptan responder (HR 0.21; p = 0.02), and dosage of furosemide < 40 mg/day (HR 0.17; p = 0.01) were factors that were independently associated with the OS. The multivariate analysis revealed that C-reactive protein < 0.9 mg/dL (HR 0.07; p = 0.001), and furosemide dosage < 40 mg/day (HR 0.09; p = 0.003) were independently associated with the tolvaptan response. Conclusion: Therapeutic response to tolvaptan was associated with longer survival in cirrhosis patients complicated with ascites. These preliminary findings warrant validation and further exploration.