- Journal Information
- Archive
- Submission
- For Reviewers
- Statement and Policies
- 个人中心
- 退出登录
浏览全部资源
扫码关注微信
- Journal Information
- Journal Introduction
- Editorial Board
- Youth Editorial Board
- Editorial Board Charter
- Subscriptions
- Archive
- Current Issue
- Past Issues
- Priority Publication
- Virtual Collection
- Recommended Articles
- Submission
- Submission Process
- Submission Guidelines
- Download
- Contact us
- For Reviewers
- Guidelines for Reviewers
- Peer Reviewed Policies
- Statement and Policies
- Ethics and Malpractice
- Research Ethics Policies
- Repetition Detection
- Corrections and Retractions
- Editorial Policies
- Open Access Statement
- Website Responsibility
Clinical observation of tolvaptan in the treatment of heart failure with preserved ejection fraction complicated with hyponatremia
- ZHONGGUO YAOFANG Vol. 35, Issue 18, Pages: 2283-2287(2024)
- 作者机构：
1.南阳医学高等专科学校第一附属医院心内科，河南 南阳 473058
2.阜外华中心血管病医院心律失常二病区，郑州 451450
- 作者简介：
- 基金信息：
DOI：10.6039/j.issn.1001-0408.2024.18.16
CLC： R969.4;R972Received：16 May 2024，
Revised：2024-08-15，
Accepted：19 August 2024，
Published：30 September 2024
- 稿件说明：
移动端阅览
穆清,李志英,张景迪,等.托伐普坦治疗射血分数保留型心力衰竭合并低钠血症的临床 观察 [J].中国药房,2024,35(18):2283-2287.
MU Qing,LI Zhiying,ZHANG Jingdi,et al.Clinical observation of tolvaptan in the treatment of heart failure with preserved ejection fraction complicated with hyponatremia[J].ZHONGGUO YAOFANG,2024,35(18):2283-2287.
穆清,李志英,张景迪,等.托伐普坦治疗射血分数保留型心力衰竭合并低钠血症的临床 观察 [J].中国药房,2024,35(18):2283-2287. DOI： 10.6039/j.issn.1001-0408.2024.18.16.
MU Qing,LI Zhiying,ZHANG Jingdi,et al.Clinical observation of tolvaptan in the treatment of heart failure with preserved ejection fraction complicated with hyponatremia[J].ZHONGGUO YAOFANG,2024,35(18):2283-2287. DOI： 10.6039/j.issn.1001-0408.2024.18.16.
摘要
目的
2
探讨托伐普坦治疗射血分数保留型心力衰竭（HFpEF）合并低钠血症的疗效和安全性。
方法
2
选择2020年1月1日－2023年6月1日南阳医学高等专科学校第一附属医院心内科收治的HFpEF合并有低钠血症患者106例，根据随机数字表法分为常规治疗组（53例）和托伐普坦组（53例）。常规治疗组患者给予常规治疗；托伐普坦组患者在常规治疗组的基础上给予托伐普坦片15 mg，24 h后增至30 mg，然后根据血清钠水平增减剂量，最大剂量不超过60 mg/d，血清钠水平≥150 mmol/L时停药。两组患者均治疗6个月。比较两组患者治疗前后的心功能指标[左室射血分数（LVEF）、左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）、氨基末端脑利钠肽前体（NT-proBNP）]、24 h尿量、血清钠、血肌酐、尿素氮水平及其变化幅度，并记录不良反应发生情况。
结果
2
治疗前，两组患者各指标组间比较，差异均无统计学意义（
P
＞0.05）。治疗后，两组患者的LVEF、24 h尿量、血清钠水平均显著高于同组治疗前，且托伐普坦组显著高于常规治疗组；LVESD、LVEDD、NT-proBNP均显著低于同组治疗前，且托伐普坦组显著低于常规治疗组（
P
＜0.05或
P
＜0.01）。托伐普坦组患者的心功能指标、24 h尿量、血清钠水平的变化均较常规治疗组更明显（
P
＜0.05）。两组患者治
疗前后的血肌酐、尿素氮水平及变化幅度，以及恶心呕吐、头晕、高钠血症、尿频的发生率比较，差异均无统计学意义（
P
＞0.05）。
结论
2
托伐普坦能够改善HFpEF合并低钠血症患者的心功能，增加血钠水平，且不影响其肾功能，不增加不良反应的发生风险。
Abstract
OBJECTIVE
2
To explore the therapeutic effect and safety of tolvaptan in the treatment of heart failure with preserved ejection fraction （HFpEF） complicated with hyponatremia.
METHODS
2
Overall 106 patients with HFpEF complicated with hyponatremia were collected from the Department of Cardiology in the First Affiliated Hospital of Nanyang Medical College from January 1， 2020 to June 1， 2023. According to the random number table， the patients were divided into conventional treatment group （
n
＝53） and tolvaptan group （
n
＝53）. The conventional treatment group was given conventional treatment. Tolvaptan group additionally received Tolvaptan tablets 15 mg on the basis of conventional treatment group， increasing to 30 mg after 24 h， and then adjusting the dosage according to the levels of serum sodium； the maximum dose should not exceed 60 mg/d， and the medication should be stopped when the serum sodium level was≥150 mmol/L. Both groups of patients were treated for 6 months. The levels and changes of cardiac function indexes [left ventricular ejection fraction （LVEF）， left ventricular end systolic diameter （LVESD）， left ventricular end diastolic diameter （LVEDD）， N-terminal pro-brain natriuretic peptide （NT-proBNP）
]
， 24 h urine output， serum sodium， blood creatinine and urea nitrogen were compared between 2 groups before and after treatment. The occurrence of adverse drug reaction （ADR） was recorded.
RESULTS
2
Before treatment， there was no statistically significant difference in those indexes between 2 groups （
P
＞0.05）. After treatment， the levels of LVEF， 24 h urine output and serum sodium in 2 groups were significantly higher than before treatment， an
d the tolvaptan group was significantly higher than the conventional treatment group； the levels of LVESD， LVEDD and NT-proBNP were significantly lower than before treatment， and the tolvaptan group was significantly lower than the conventional treatment group （
P
＜0.05 or
P
＜0.01）. The changes in cardiac function indexes， 24 h urine output and serum sodium levels in the atorvastatin group were more significant than the conventional treatment group （
P
＜0.05）. There was no statistically significant difference in the levels and changes of blood creatinine and urea nitrogen before and after treatment， as well as the incidence of nausea and vomiting， dizziness， hypernatremia and frequent urination between 2 groups （
P
＞0.05）.
CONCLUSIONS
2
Tolvaptan can improve cardiac function and increase the blood sodium levels in patients with HFpEF complicated with hyponatremia， without affecting their renal function or increasing the risk of ADR.
关键词
Keywords
references
GERBER Y ， WESTON S A ， REDFIELD M M ， et al . A contemporary appraisal of the heart failure epidemic in Olmsted County，Minnesota，2000 to 2010 [J ] . JAMA Intern Med ， 2015 ， 175 （ 6 ）： 996 - 1004 .
TSAO C W ， LYASS A ， ENSERRO D ， et al . Temporal trends in the incidence of and mortality associated with heart failure with preserved and reduced ejection fraction [J ] . JACC Heart Fail ， 2018 ， 6 （ 8 ）： 678 - 685 .
STEINBERG B A ， ZHAO X ， HEIDENREICH P A ， et al . Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction：prevalence，therapies，and outcomes [J ] . Circulation ， 2012 ， 126 （ 1 ）： 65 - 75 .
BHAMBHANI V ， KIZER J R ， LIMA J A C ， et al . Predictors and outcomes of heart failure with mid-range ejection fraction [J ] . Eur J Heart Fail ， 2018 ， 20 （ 4 ）： 651 - 659 .
SHAH K S ， XU H L ， MATSOUAKA R A ， et al . Heart fai-lure with preserved，borderline，and reduced ejection fraction：5-year outcomes [J ] . J Am Coll Cardiol ， 2017 ， 70 （ 20 ）： 2476 - 2486 .
刘莉 ， 刘燕 ， 卢京九 . 沙库巴曲缬沙坦治疗射血分数保留型心衰临床效果 [J ] . 分子诊断与治疗杂志 ， 2022 ， 14 （ 4 ）： 680 - 684 .
LIU L ， LIU Y ， LU J J . Clinical effect of shacubacrevalsartan in the treatment of ejection fraction-preserved heart failure [J ] . J Mol Diagn Ther ， 2022 ， 14 （ 4 ）： 680 - 684 .
SATO Y ， YOSHIHISA A ， OIKAWA M ， et al . Hypona-tremia at discharge is associated with adverse prognosis in acute heart failure syndromes with preserved ejection fraction：a report from the JASPER registry [J ] . Eur Heart J Acute Cardiovasc Care ， 2019 ， 8 （ 7 ）： 623 - 633 .
SU Y ， MA M Q ， ZHANG H B ， et al . Prognostic value of serum hyponatremia for outcomes in patients with heart failure with preserved ejection fraction：an observational cohort study [J ] . Exp Ther Med ， 2020 ， 20 （ 5 ）： 101 .
NISHIKAWA R ， KATO T ， MORIMOTO T ， et al . The characteristics and outcomes in patients with acute heart failure who used tolvaptan：from KCHF registry [J ] . ESC Heart Fail ， 2023 ， 10 （ 5 ）： 3141 - 3151 .
中华医学会心血管病学分会心力衰竭学组 ， 中国医师协会心力衰竭专业委员会 ， 中华心血管病杂志编辑委员会 . 中国心力衰竭诊断和治疗指南2018 [J ] . 中华心血管病杂志 ， 2018 ， 46 （ 10 ）： 760 - 789 .
Heart Failure Group of the Cardiovascular Disease Branch of the Chinese Medical Association ， Heart Failure Professional Committee of the Chinese Medical Association ， Editorial Committee of the Chinese Journal of Cardiovascular Disease . China guidelines for diagnosis and treatment of heart failure 2018 [J ] . Chin J Cardiol ， 2018 ， 46 （ 10 ）： 760 - 789 .
RUSINARU D ， BUICIUC O ， LEBORGNE L ， et al . Relation of serum sodium level to long-term outcome after a first hospitalization for heart failure with preserved ejection fraction [J ] . Am J Cardiol ， 2009 ， 103 （ 3 ）： 405 - 410 .
UPADHYAY A ， JABER B L ， MADIAS N E . Incidence and prevalence of hyponatremia [J ] . Am J Med ， 2006 ， 119 （7 Suppl. 1 ）： S30 - S35 .
PARK J J ， CHO Y J ， OH I Y ， et al . Short and long-term prognostic value of hyponatremia in heart failure with preserved ejection fraction versus reduced ejection fraction：an analysis of the Korean Acute Heart Failure Registry [J ] . Int J Cardiol ， 2017 ， 248 ： 239 - 245 .
MILLER W L ， BORGESON D D ， GRANTHAM J A ， et al . Dietary sodium modulation of aldosterone activation and renal function during the progression of experimental heart failure [J ] . Eur J Heart Fail ， 2015 ， 17 （ 2 ）： 144 - 150 .
夏莹 ， 贾磊 . 托伐普坦联合沙库巴曲缬沙坦钠治疗慢性心力衰竭的临床疗效及其对心功能的影响 [J ] . 临床合理用药杂志 ， 2021 ， 14 （ 27 ）： 56 - 58 .
XIA Y ， JIA L . Clinical efficacy of tolvaptan combined with shacubacrevalsartan sodium in the treatment of chronic heart failure and its influence on cardiac function [J ] . Chin J Clin Ration Drug Use ， 2021 ， 14 （ 27 ）： 56 - 58 .
GHEORGHIADE M ， NIAZI I ， OUYANG J ， et al . Vasopressin V2-receptor blockade with tolvaptan in patients with chronic heart failure：results from a double-blind，randomized trial [J ] . Circulation ， 2003 ， 107 （ 21 ）： 2690 - 2696 .
GHEORGHIADE M ， KONSTAM M A ， BURNETT J C ， Jr ， et al . Short-term clinical effects of tolvaptan，an oral vasopressin antagonist，in patients hospitalized for heart fai-lure：the EVEREST clinical status trials [J ] . JAMA ， 2007 ， 297 （ 12 ）： 1332 - 1343 .
ALSKAF E ， TRIDENTE A ， AL-MOHAMMAD A . Tolvaptan for heart failure，systematic review and meta-analysis of trials [J ] . J Cardiovasc Pharmacol ， 2016 ， 68 （ 3 ）： 196 - 203 .
HITOMI Y ， NAGATOMO Y ， YUKINO M ， et al . Characterization of tolvaptan response and its impact on the outcome for patients with heart failure [J ] . J Cardiol ， 2021 ， 78 （ 4 ）： 285 - 293 .
MAEDER M T ， RICKLI H ， PFISTERER M E ， et al . Incidence，clinical predictors，and prognostic impact of wor-sening renal function in elderly patients with chronic heart failure on intensive medical therapy [J ] . Am Heart J ， 2012 ， 163 （ 3 ）： 407 - 414，414 .e1.
NAKANO Y ， MIZUNO T ， NIWA T ， et al . Impact of continuous administration of tolvaptan on preventing medium-term worsening renal function and long-term adverse events in heart failure patients with chronic kidney disease [J ] . Int Heart J ， 2018 ， 59 （ 1 ）： 105 - 111 .
COSTELLO-BOERRIGTER L C ， SMITH W B ， BOERRIGTER G ， et al . Vasopressin-2-receptor antagonism augments water excretion without changes in renal hemodynamics or sodium and potassium excretion in human heart failure [J ] . Am J Physiol Renal Physiol ， 2006 ， 290 （ 2 ）： F273 - F278 .
0
Views
207
下载量
0
CSCD
- L-PDFDownload
- WORDDownload
- Meta-XMLDownload
- BibTeXDownload
- EndnoteDownload
- RefMan Download
- NoteExpressDownload
- NoteFirstDownload
Publicity Resources
Related Articles
Related Author
Related Institution
- Address：8th Floor, Sihuan Building, No. 129 Daping Main Street, Yuzhong District, Chongqing, China Postal code：400042
- Technical support is provided by Beijing Founder Electronics co., LTD 渝ICP备15012710号
公网安备50010302001817 - It is recommended to read the content of this site in Chrome&IE9+. Please switch to extreme mode in browser 360.
- Cookies We use cookies to help provide and enhance our service and tailor content. By continuing, you agree to the use of cookies.