Sakaida Isao
Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami Kogushi, Ube, Yamaguchi 755-8505, Japan.
Expert Rev Gastroenterol Hepatol. 2014 Jul;8(5):461-70. doi: 10.1586/17474124.2014.903797. Epub 2014 Mar 29.
No alternative therapeutic option exists if liver cirrhosis patients have insufficient response to conventional diuretics and/or experience conventional diuretic-related adverse events. In 2013, tolvaptan (7.5 mg/day), an arginine vasopressin V2 receptor antagonist, was approved in Japan for the treatment of liver cirrhosis with oedema. Short-term use of tolvaptan produced decreases in body weight, reduction in ascites volume and increases in urine volume when compared to placebo, despite the use of conventional diuretics. Additionally, approximately 60% of patients with oedema-related symptoms improved. Low-dose tolvaptan, 3.75 mg, was also efficacious. Even in patients with low serum albumin (<2.5 g/dL), decrease in body weight was greater with tolvaptan than with placebo. For future research, the efficacy and safety of lower tolvaptan doses for the treatment of liver cirrhosis patients with oedema should be confirmed in Japan. The results of this research could be used as an indicator or a guideline for physicians around the world.
如果肝硬化患者对传统利尿剂反应不足和/或出现与传统利尿剂相关的不良事件，就不存在其他治疗选择。2013年，精氨酸加压素V2受体拮抗剂托伐普坦（7.5毫克/天）在日本被批准用于治疗伴有水肿的肝硬化。与安慰剂相比，短期使用托伐普坦可使体重下降、腹水量减少、尿量增加，尽管同时使用了传统利尿剂。此外，约60%有水肿相关症状的患者病情有所改善。低剂量的托伐普坦（3.75毫克）也有效。即使是血清白蛋白水平低（<2.5克/分升）的患者，托伐普坦组的体重下降幅度也大于安慰剂组。对于未来的研究，应在日本确认更低剂量托伐普坦治疗肝硬化伴水肿患者的疗效和安全性。本研究结果可作为全球医生的参考指标或指南。
