Farmakis Dimitrios, Filippatos Gerasimos, Kremastinos Dimitrios T, Gheorghiade Mihai
Curr Heart Fail Rep. 2008 Jun;5(2):91-6. doi: 10.1007/s11897-008-0015-z.
Increased synthesis of arginine vasopressin (AVP) plays a critical role in fluid retention and hyponatremia in patients with heart failure. The AVP receptor antagonists constitute a new class of agents that are promising in the management of hyponatremia and congestion. Three of these agents--conivaptan, tolvaptan, and lixivaptan--have been studied in clinical settings. All are effective in inducing aquaresis (ie, electrolyte-free water excretion) and normalizing serum sodium concentration. They are well tolerated without causing electrolyte disorders, hypotension, or renal impairment. Conivaptan has been approved by the US Food and Drug Administration for short-term intravenous treatment of euvolemic hyponatremia of variable etiology but has not been adequately studied in heart failure. The addition of tolvaptan to standard therapy in hospitalized patients with heart failure has led to symptomatic improvement and decreased body weight, but there is no long-term clinical benefit. Early data on lixivaptan in heart failure suggest a dose-dependent aquaresis effect, and larger studies are under way.
精氨酸加压素（AVP）合成增加在心力衰竭患者的液体潴留和低钠血症中起关键作用。AVP受体拮抗剂构成了一类新型药物，在低钠血症和充血的治疗中前景广阔。其中三种药物——考尼伐坦、托伐普坦和利伐普坦——已在临床环境中进行了研究。所有这些药物在诱导排水利尿（即无电解质的水排泄）和使血清钠浓度正常化方面均有效。它们耐受性良好，不会引起电解质紊乱、低血压或肾功能损害。考尼伐坦已获美国食品药品监督管理局批准，用于短期静脉治疗各种病因的等容性低钠血症，但尚未在心力衰竭患者中进行充分研究。在住院心力衰竭患者的标准治疗中加用托伐普坦已带来症状改善和体重减轻，但尚无长期临床益处。关于利伐普坦治疗心力衰竭的早期数据表明其具有剂量依赖性排水利尿作用，更大规模的研究正在进行中。
