摘要
目的:评价托伐普坦治疗肝硬化并低钠血症和肝性水肿的有效性及安全性.方法:检索Embase、Pub Med、Medline、Cochrane Library、Google Scholar、中国知网、维普、万方关于托伐普坦治疗肝硬化并低钠血症和肝性水肿的随机对照试验(RCT),提取相关研究数据,使用Rev Man5.3版软件进行系统评价和Meta分析.结果:8项随机对照试验共725例患者符合纳入标准.Meta分析结果显示与安慰剂相比托伐普坦能显著升高血清钠浓度[加权均数差(weighted mean difference,WMD)=7.36m m o l/L,95%C I:4.15-10.57,P<0.001],显著增加24 h尿量(WMD=1060.98 m L/24 h95%CI:529.43-1592.52,P<0.001),降低体质量及腹围(体质量:WMD=-1.14 kg,95%CI:-1.34--0.94,P<0.001;腹围:WMD=-2.18 cm95%C I:-3.02--1.34,P<0.001).托伐普坦与安慰剂相比对血清钾浓度、血清肌酐、心率、收缩压、舒张压的影响无差异(P>0.05)在不良反应发生率上,托伐普坦与安慰剂相比无统计学差异(RR=1.43,95%CI:0.73-2.80,P=0.300).结论:对于肝硬化并低钠血症和肝性水肿患者,托伐普坦能够在短期内提升血清钠浓度,增加尿量,减轻水肿,且不增加不良反应,是肝硬化并低钠血症和肝性水肿治疗有价值的新药物.
AIM：To evaluate the efficacy and safety of vasopressin V2-receptor antagonist tolvaptan in treating cirrhotic patients with hyponatremia and hepatic edema.METHODS：Randomized controlled trials（RCTs） about tolvaptan in treating cirrhotic patients with hyponatremia and hepatic edema were searched from the following databases：Embase,PubMed,Medline,Cochrane Library,Google Scholar,China National Knowledge Infrastructure（CNKI）,VIP and Wanfang Database.The related research data were extracted,and RevMan5.3 was used for systemic review and meta-analysis.RESULTS：Eight RCTs including 725 patients met the inclusion criteria.Meta-analysis showed that compared with placebo,tolvaptan could significantly increase serum sodium concentration[weighted mean difference（WMD） = 7.36 mmol/L,95%CI：4.15-10.57,P〈0.001]and 24-h urine volume（WMD = 1060.98mL/24 h,95%CI：529.43-1592.52,P〈0.001）,and reduce the body weight and abdominal circumference（body weight：WMD =-1.14 kg,95%CI：-1.34--0.94,P〈0.001;abdominal circumference：WMD =-2.18 cm,95%CI：-3.02--l.34,P〈0.001）.The effects of tolvaptan on serum potassium,serum creatinine,heart rate,systolic pressure and diastolic pressure were not statistically different from those of the placebo（P〈0.05）.The incidence of adverse reactions were not statistically different between the tolvaptan and placebo groups（RR= 1.43,95%CI：0.73-2.80,P = 0.300）.CONCLUSION：Tolvaptan could provide a new drug option for cirrhotic patients with hyponatremia and hepatic edema.
出处
《世界华人消化杂志》
CAS
2016年第6期938-946,共9页
World Chinese Journal of Digestology
