Effect of tolvaptan on the prognosis of patients with hepatic ascites
Effect of tolvaptan on the prognosis of patients with hepatic ascites
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DOI：
10.1111/hepr.13337
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发表时间：
2019-07-01
影响因子：
4.2
通讯作者：
Ido, Akio
中科院分区：
文献类型：
--
作者：
Hiramine, Yasunari;Uto, Hirofumi;Ido, Akio
目的尽管有越来越多的证据表明托伐普坦治疗体液潴留或低钠血症的疗效，但托伐普坦对肝性腹水患者预后的影响尚未得到充分的研究。方法纳入2007年至2017年期间接受利尿剂（呋塞米、吡内酯或托伐普坦）治疗的肝性腹水患者628例，分为两组：接受托伐普坦治疗组（原托伐普坦组，n = 278）和未接受托伐普坦治疗组（原对照组，n = 350）。比较两组间的累积生存率，并使用Cox回归分析确定与肝性腹水患者生存相关的因素。此外，对2013年9月以后开始使用常规利尿剂治疗新发肝性腹水的患者（托伐普坦配对前组，n = 177；托伐普坦配对前对照组，n = 63）进行倾向评分匹配，比较托伐普坦配对后组与对照组的累积生存率。结果托伐普坦治疗组患者生存率显著高于对照组（P = 0.005），托伐普坦治疗是影响患者生存率的独立因素（死亡风险比为0.721,P < 0.001）。倾向评分匹配比较也显示，托伐普坦组（n = 51）的生存率显著高于对照组（n = 51） （P = 0.009）。结论托伐普坦可改善肝性腹水患者的预后。
Aim Despite accumulating evidence concerning the efficacy of tolvaptan in the treatment of body fluid retention or hyponatremia, the effect of tolvaptan on the prognosis of patients with hepatic ascites has not been fully investigated. Methods A total of 628 patients with hepatic ascites who were treated with diuretics (furosemide, spironolactone, or tolvaptan) between 2007 and 2017 were enrolled and divided into two groups: those who received tolvaptan (original tolvaptan group, n = 278) and those who did not (original control group, n = 350). The cumulative survival rates between the groups were compared and the factors associated with survival in patients with hepatic ascites were identified using a Cox regression analysis. In addition, propensity score matching was applied in patients who started conventional diuretics for new-onset hepatic ascites after September 2013 (pre-matching tolvaptan group, n = 177; pre-matching control group, n = 63), and the cumulative survival rates were compared between the post-matching tolvaptan and control groups. Results The survival rate was significantly higher in the tolvaptan group than the control group (P = 0.005), and tolvaptan therapy was identified as an independent factor associated with survival (hazard ratio 0.721 for death relative to control, P < 0.001). The propensity score-matched comparison also showed a significantly higher survival rate in the tolvaptan group (n = 51) than in the control group (n = 51) (P = 0.009). Conclusions This study suggests that tolvaptan might improve the prognosis of patients with hepatic ascites.