Potential Effectiveness of Tolvaptan to Improve Ascites Unresponsive to Standard Diuretics and Overall Survival in Patients with Decompensated Liver Cirrhosis
Potential Effectiveness of Tolvaptan to Improve Ascites Unresponsive to Standard Diuretics and Overall Survival in Patients with Decompensated Liver Cirrhosis
复制标题
托伐普坦改善失代偿性肝硬化患者对标准利尿剂无反应的腹水和总体生存率的潜在功效
DOI：
10.1007/s40261-016-0434-7
复制
发表时间：
2016
影响因子：
3.2
通讯作者：
K. Tagawa
中科院分区：
文献类型：
--
作者：
Tomoharu Yamada;Takamasa Ohki;Y. Hayata;Y. Karasawa;S. Kawamura;Daisaku Ito;K. Kojima;Michiharu Seki;N. Toda;K. Tagawa
托伐普坦被批准用于治疗肝硬化腹水患者后，只有少数研究报道了其在真实的临床环境中的疗效，没有研究报道其对总生存率的贡献。本研究阐明了托伐普坦治疗的临床结果，改善腹水无反应的标准利尿剂（AUS）和总survival.MethodsWe回顾性招募了80失代偿期肝硬化患者AUS谁是管理托伐普坦从2012年10月至2014年12月。根据腹水改善情况分为两组。我们比较了实验室检查结果和总生存率，并分析了影响总生存率的因素。ResultsOf 80例患者中，59例（73.8%）为男性，中位年龄为70岁。39例（48.8%）患者为Child-Pugh C级，36例（45.0%）为晚期肝细胞癌（HCC）。托伐普坦在48例（60.0%）患者中有效，平均体重减轻3.8 kg，32例（40.0%）患者无效。两组的累积生存率差异显著（p <0.0001），有效组30天和90天的生存率分别为87.5%和68.0%，无效组分别为50.0%和30.5%。多变量分析表明，改善AUS，先进的HCC，总胆红素水平，血尿素氮水平，低钠血症的存在是独立的预测因子的总survival.ConclusionsTolvaptan可能会提高总生存率在失代偿期肝硬化患者AUS，只要它被证明是有效的，在这些患者。
Background and ObjectiveAfter tolvaptan was approved for the treatment of cirrhosis patients with ascites, only a few studies have reported its efficacy in the real clinical setting, and no studies have reported its contribution to overall survival. This study clarified the clinical outcomes of tolvaptan treatment in terms of improving ascites unresponsive to standard diuretics (AUS) and overall survival.MethodsWe retrospectively enrolled 80 decompensated cirrhosis patients with AUS who were administered tolvaptan from October 2012 to December 2014. The patients were divided into two groups according to ascites improvement. We compared laboratory results and overall survival and analyzed factors that affected overall survival.ResultsOf the 80 patients, 59 (73.8 %) were male and the median age was 70 years. Thirty-nine (48.8 %) patients were Child–Pugh class C, and 36 (45.0 %) had advanced hepatocellular carcinoma (HCC). Tolvaptan was effective in 48 (60.0 %) patients with an average 3.8 kg weight reduction and ineffective in 32 (40.0 %) patients. The cumulative survival rate differed significantly between the two groups (p < 0.0001), with 87.5 and 68.0 % survival at 30 and 90 days, respectively, in the effective group, and 50.0 and 30.5 % survival, respectively, in the ineffective group. Multivariate analysis showed that improvement in AUS, advanced HCC, total bilirubin level, blood urea nitrogen level, and the presence of hyponatremia were independent predictors of overall survival.ConclusionsTolvaptan could possibly improve overall survival in decompensated cirrhosis patients with AUS as long as it was demonstrated to be effective in these patients.