Nakai Masato, Suda Goki, Kubo Akinori, Tokuchi Yoshimasa, Kitagataya Takashi, Yamada Ren, Shigesawa Taku, Suzuki Kazuharu, Nakamura Akihisa, Kawagishi Naoki, Ohara Masatsugu, Umemura Machiko, Sho Takuya, Morikawa Kenichi, Ogawa Koji, Sakamoto Naoya
Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7 Kita-ku, Sapporo, 060-8638, Japan.
J Gastroenterol. 2020 Dec;55(12):1150-1161. doi: 10.1007/s00535-020-01721-8. Epub 2020 Aug 26.
Decompensated liver cirrhosis patients with refractory ascites or pleural effusion have a poor prognosis. Tolvaptan has been used for treating water retention associated with cirrhosis. However, despite the short-term response, water retention recurrence is still observed in some cases. This study aimed to clarify the water retention recurrence rate and the relationship between long-term response without recurrence and prognosis.
Altogether, 100 patients with decompensated cirrhosis treated with tolvaptan were retrospectively analyzed. Recurrence was evaluated according to the criteria of the EASL clinical practice guideline. The recurrence rate and prognosis of non-responders, patients with recurrence, and long-term responders were analyzed. The baseline factors related to short-term response, recurrence, and long-term response were also evaluated.
Approximately 31.0% of the short-term responders had recurrence. Although there was no significant difference in the prognosis by short-term response (p = 0.07), the long-term responders had a significantly better prognosis than those with recurrence and non-responders (p < 0.01). Low CRP levels and high urinary Na/K ratios were significant factors related to short-term response, and the presence of acute kidney injury was also a factor related to non-response. The low CRP level (relapse: < 1.10 mg/dl, long-term response: < 0.94 mg/dl) was identified as a factor related to recurrence and long-term response.
The long-term responders without recurrence had a significantly better prognosis. CRP was a useful predictor for long-term response, whereas renal function parameters were useful predictors for short-term response. Inflammation control may be important for long-term response and prognosis in cirrhosis patients with water retention.
失代偿期肝硬化合并难治性腹水或胸腔积液的患者预后较差。托伐普坦已被用于治疗肝硬化相关的水潴留。然而，尽管有短期疗效，但仍有一些病例出现水潴留复发。本研究旨在明确水潴留复发率以及无复发的长期疗效与预后之间的关系。
对100例接受托伐普坦治疗的失代偿期肝硬化患者进行回顾性分析。根据欧洲肝脏研究学会（EASL）临床实践指南的标准评估复发情况。分析无反应者、复发患者和长期反应者的复发率及预后。还评估了与短期疗效、复发和长期疗效相关的基线因素。
约31.0%的短期反应者出现复发。尽管短期疗效对预后无显著差异（p = 0.07），但长期反应者的预后明显优于复发患者和无反应者（p < 0.01）。低CRP水平和高尿钠/钾比值是与短期疗效相关的显著因素，急性肾损伤的存在也是与无反应相关的因素。低CRP水平（复发：< 1.10 mg/dl，长期反应：< 0.94 mg/dl）被确定为与复发和长期反应相关的因素。
无复发的长期反应者预后明显更好。CRP是长期反应的有用预测指标，而肾功能参数是短期疗效的有用预测指标。控制炎症可能对失代偿期肝硬化水潴留患者的长期疗效和预后很重要。
