Shimizu Keisuke, Doi Kent, Imamura Teruhiko, Noiri Eisei, Yahagi Naoki, Nangaku Masaomi, Kinugawa Koichiro
Clinical Research Training Program, The University of Tokyo, Tokyo, Japan.
Nephrology (Carlton). 2015 Jun;20(6):405-12. doi: 10.1111/nep.12406.
This study was conducted to evaluate the performance of the ratio of urine and blood urea nitrogen concentration (UUN/BUN) as a new predictive factor for the response of an arginine vasopressin receptor 2 antagonist tolvaptan (TLV) in decompensated heart failure patients.
This study enrolled 70 decompensated heart failure patients who were administered TLV at University of Tokyo Hospital. We collected the data of clinical parameters including UUN/BUN before administering TLV. Two different outcomes were defined as follows: having over 300 mL increase in urine volume on the first day (immediate urine output response) and having any decrease in body weight within one week after starting TLV treatment (subsequent clinical response).
Among the 70 enrolled patients, 37 patients (52.9%) showed immediate urine output response; 51 patients (72.9%) showed a subsequent clinical response of body weight decrease. Receiver operating characteristics (ROC) analysis showed good prediction by UUN/BUN for the immediate response (AUC-ROC 0.86 [0.75-0.93]) and a significantly better prediction by UUN/BUN for the subsequent clinical response compared with urinary osmolality (AUC-ROC 0.78 [0.63-0.88] vs. 0.68 [0.52-0.80], P < 0.05).
We demonstrated that a clinical parameter of UUN/BUN can predict the response of TLV even when measured before TLV administration. UUN/BUN might enable identification of good responders for this new drug.
本研究旨在评估尿与血尿素氮浓度比值（UUN/BUN）作为精氨酸加压素受体2拮抗剂托伐普坦（TLV）对失代偿性心力衰竭患者反应的新预测因子的性能。
本研究纳入了70例在东京大学医院接受TLV治疗的失代偿性心力衰竭患者。我们收集了在给予TLV之前包括UUN/BUN在内的临床参数数据。定义了两种不同的结果如下：第一天尿量增加超过300 mL（即刻尿量反应）以及在开始TLV治疗后一周内体重有任何下降（后续临床反应）。
在70例纳入的患者中，37例（52.9%）表现出即刻尿量反应；51例（72.9%）表现出后续体重下降的临床反应。受试者工作特征（ROC）分析显示UUN/BUN对即刻反应有良好的预测能力（AUC-ROC 0.86 [0.75 - 0.93]），并且与尿渗透压相比，UUN/BUN对后续临床反应的预测能力显著更好（AUC-ROC 0.78 [0.63 - 0.88] 对比 0.68 [0.52 - 0.80]，P < 0.05）。
我们证明即使在给予TLV之前测量，UUN/BUN这一临床参数也能预测TLV的反应。UUN/BUN可能有助于识别这种新药的良好反应者。
