Survival Benefit of Tolvaptan for Refractory Ascites in Patients with Advanced Cirrhosis.
Survival Benefit of Tolvaptan for Refractory Ascites in Patients with Advanced Cirrhosis.
复制标题
托伐普坦对晚期肝硬化难治性腹水患者的生存益处。
DOI：
10.1159/000489258
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Sugiyama T.
中科院分区：
文献类型：
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作者：
Tajiri K;Tokimitsu Y;Ito H;Atarashi Y;Kawai K;Minemura M;Yasumura S;Takahara T;Shimizu Y;Sugiyama T.
目的评价托伐普坦对失代偿期肝硬变顽固性腹水患者生存率的影响。方法采用多中心、回顾性、观察性研究方法对对利尿剂无效的肝性腹水患者进行托伐普坦治疗。结果托伐普坦治疗后1周体重中位数变化为-1.95 kg，50%的患者体重下降2 kg/周。研究发现，与肝功能和肝纤维化标记物相比，局部尿钠更能预测托伐普坦的疗效。服用托伐普坦12周后，减少组的中位生存期显著延长(未达到的中位生存期比116天，p=0.005)，血肌酐浓度显著降低(0.99vs.1.55 mg/dL，p<；0.05)。多因素分析显示存活的肝细胞癌的存在(危险比[HR]2.14，p=0.02)和利尿剂的减少是生存的独立预后因素(HR 0.36，p<；0.01)。结论维持肾功能是提高肝硬化患者生存的关键。在托伐普坦治疗期间应适当调整利尿剂的剂量。
AimsThe study aimed to evaluate the effects of tolvaptan treatment on survival of patients with decompensated liver cirrhosis with refractory ascites.MethodsThis multicenter, retrospective, observational study included patients with cirrhosis who were treated with tolvaptan for hepatic ascites refractory to conventional diuretics. Patients who could and could not decrease accompanying diuretics within 1 month after tolvaptan administration were defined as the “Decreased” and “Not-decreased” groups, respectively.ResultsMedian body weight change 1 week after tolvaptan treatment was–1.95 kg, with the 50% of patients experiencing a 2 kg/week reduction. Spot urinary sodium was found to be a better predictor of tolvaptan response than liver function and liver fibrosis markers. Median survival was significantly longer (not reached versus 116 days, p= 0.005) and serum creatinine concentrations 12 weeks after tolvaptan administration significantly lower (0.99 vs. 1.55 mg/dL, p< 0.05) in the Decreased than in the Not-decreased group. Multivariate analysis showed that the presence of viable hepatocellular carcinoma (hazards ratio [HR] 2.14, p= 0.02) and a decrease in diuretics were independently prognostic of survival (HR 0.36, p< 0.01).ConclusionsThe maintenance of renal function is essential in enhancing survival of patients with cirrhosis. Doses of diuretics should be adjusted appropriately during tolvaptan treatment.