Imamura Teruhiko, Kinugawa Koichiro, Minatsuki Shun, Muraoka Hironori, Kato Naoko, Inaba Toshiro, Maki Hisataka, Hatano Masaru, Yao Atsushi, Komuro Issei
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.
Int Heart J. 2013;54(6):377-81. doi: 10.1536/ihj.54.377.
We previously defined "responders" as patients with increases in urine volume (UV) on day 1 after the administration of tolvaptan (TLV), and demonstrated that responders to TLV could be predicted with considerable accuracy by urine osmolality (U-OSM) levels. Responders and non-responders to TLV should be associated with different clinical courses after a certain time following TLV administration. Therefore, the aim of the present study was to validate our definition of responders by clinical parameters 1 week after administration of TLV. Data (n = 85) were obtained from in hospital patients with decompensated heart failure (HF) who had received TLV at 3.75-15 mg daily, and clinical data at 1 week after the administration of TLV were compared with those of baseline. Sixty patients (70.6%) were "responders", in whom UV on day 1 increased after the administration of TLV compared with day 0. "Non-responders" were older, and had higher serum creatinine concentration and lower baseline U-OSM than "responders". Serum creatinine concentration increased significantly in "non-responders", but was unchanged in "responders". Body weight, plasma B-type natriuretic peptide concentration, and HF symptom score decreased significantly in "responders", but remained unchanged in "non-responders". Increases in UV after the first administration of TLV were closely correlated with improvement of congestive HF after 1 week of TLV treatment, which verified our definition of "responders" to TLV.
我们之前将“反应者”定义为服用托伐普坦（TLV）后第1天尿量（UV）增加的患者，并证明通过尿渗透压（U-OSM）水平可以相当准确地预测对TLV的反应者。对TLV的反应者和无反应者在服用TLV后的一定时间后应与不同的临床病程相关。因此，本研究的目的是通过TLV给药1周后的临床参数来验证我们对反应者的定义。数据（n = 85）来自住院的失代偿性心力衰竭（HF）患者，这些患者每天接受3.75 - 15 mg的TLV，并将TLV给药1周后的临床数据与基线数据进行比较。60名患者（70.6%）为“反应者”，与给药前第0天相比，这些患者在服用TLV后第1天的UV增加。“无反应者 ”年龄更大，血清肌酐浓度更高，基线U-OSM低于“反应者”。“无反应者”的血清肌酐浓度显著升高，但“反应者”的血清肌酐浓度无变化。“反应者”的体重、血浆B型利钠肽浓度和HF症状评分显著降低，但“无反应者”保持不变。首次服用TLV后UV的增加与TLV治疗1周后充血性HF的改善密切相关，这验证了我们对TLV“反应者”的定义。
