Park Gun Ha, Lee Chang Min, Song Jae Won, Jung Moon Chan, Kim Jwa Kyung, Song Young Rim, Kim Hyung Jik, Kim Sung Gyun
Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea.
Korean J Intern Med. 2018 May;33(3):561-567. doi: 10.3904/kjim.2016.155. Epub 2017 Mar 13.
BACKGROUND/AIMS: Tolvaptan is a very effective treatment for hypervolemic or euvolemic hyponatremia. We compared the clinical efficacy of and response to tolvaptan in patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and congestive heart failure (CHF).
We retrospectively reviewed the medical records of 50 patients (SIADH, n = 30; CHF, n = 20) who were prescribed tolvaptan between July 2013 and October 2015. Tolvaptan was prescribed when the serum sodium level was < 125 mmol/L and the standard treatment failed. Normonatremia was defined as a serum sodium level of > 135 mmol/L.
After the initiation of tolvaptan therapy, there was an immediate response in the urine volume and serum sodium level in all patients. The improvements in the urine volume and serum sodium concentration were highest within the first 24 hours of treatment. In addition, the mean change in the serum sodium level during the first 24 hours was significantly higher in patients with SIADH than in those with CHF (∆Na, 9.9 ± 4.5 mmol/L vs. 6.9 ± 4.4 mmol/L, respectively; = 0.025). Also, the mean maintenance dose was lower, and the total duration of tolvaptan use was slightly shorter in the SIADH group than CHF group (21.5 ± 14.9 days vs. 28.0 ± 20.1 days, = 0.070).
The early response to tolvaptan treatment was better in patients with SIADH than in those with CHF. Thus, the tolvaptan treatment strategy should be differed between patients with SIADH and those with CHF.
背景/目的：托伐普坦是治疗高容量性或等容量性低钠血症的一种非常有效的药物。我们比较了托伐普坦对抗利尿激素分泌异常综合征（SIADH）和充血性心力衰竭（CHF）患者的临床疗效及反应。
我们回顾性分析了2013年7月至2015年10月期间接受托伐普坦治疗的50例患者（SIADH患者30例，CHF患者20例）的病历。当血清钠水平<125 mmol/L且标准治疗失败时使用托伐普坦。血钠正常定义为血清钠水平>135 mmol/L。
开始托伐普坦治疗后，所有患者的尿量和血清钠水平均立即出现反应。治疗的前24小时内尿量和血清钠浓度的改善最为明显。此外，SIADH患者治疗后第1天血清钠水平的平均变化显著高于CHF患者（分别为∆Na，9.9±4.5 mmol/L对6.9±4.4 mmol/L；P = 0.025）。而且，SIADH组的平均维持剂量较低，托伐普坦的总使用时间略短于CHF组（21.5±14.9天对28.0±20.1天，P = 0.070）。
SIADH患者对托伐普坦治疗的早期反应优于CHF患者。因此，SIADH患者和CHF患者的托伐普坦治疗策略应有所不同。
