Abstract:

Objective　To explore the effect of tovaptan combined with hydrochlorothiazide forrefractory edema in patients with nephrotic syndrome (NS). Methods　Ninety patients with NS admitted to Liaocheng Third People's Hospital from February 2022 to February 2023 were divided into a routine group and a study group by the random number table method, with 45 cases in each group. There were 15 females and 30 males in the routine group; they were 28-67 (49.02±5.14) years old; their disease course was 6-32 (15.59±4.36) months; there were 29 cases of moderate edema and 16 cases of severe edema; their 24 h urine volume was (698.04±98.75) ml. There were 16 females and 29 males in the study group; they were 30-68 (48.76±4.98) years old; their disease course was 5-33 (16.02±4.15) months; there were 27 cases of moderate edema and 18 cases of severe edema; their 24 h urine volume was (703.45±103.45) ml. The routine group were treated with hydrochlorothiazide, and the study group with tolvaptan and hydrochlorothiazide. Both groups were treated for 14 d. The clinical efficacies, edema resolution times, adverse reactions, body weights before and after the treatment, renal function indicators [urea nitrogen (BUN), urine albumin (Upro), and blood creatinine (Scr)], urine routine [24 h urine volume, urine sodium, and urine potassium excretion], serum cystatin C (Cys-C), N-terminal pro-brain natriuretic peptide (NT-proBNP), and transforming growth factor-β (TGF-β) were compared between the two groups. χ² and t tests were used. Results　The total effective rate of the study group was higher than that in the routine group [91.11% (41/45) vs. 73.33% (33/45)], with a statistical difference (χ²=4.87; P<0.05). After the treatment, the weight and edema resolution time in the study group were lower than those in the routine group [(62.39±2.87) kg vs. (67.96±3.62) kg and (9.04±2.24) d vs.(11.41±3.01) d], with statistical differences (t=8.09 and 4.24; both P<0.05). After the treatment, the levels of BUN, Upro, and Scr in the study group were lower than those in the routine group [(12.46±2.15) mmol/L vs. (16.46±1.89) mmol/L, (1.29±0.32) g/24 h vs. (1.88±0.38) g/24 h, and (217.24±93.26) mmol/L vs. (273.48±101.15) mmol/L], with statistical differences (t=9.37, 7.97, and 2.74; all P<0.05). After the treatment, the 24 h urine volume of the study group was higher than that of the routine group [(1814.58±189.47) ml/24 h vs. (1 340.86±201.32) ml/24 h], with a statistical difference (t=11.50; P<0.05). After the treatment, the levels of NT-proBNP, Cys-C, and TGF-β in the study group were lower than those in the routine group [(5 140.29±25.89) ng/L vs. (6 128.56±30.45) ng/L, (1.87±0.34) mg/L vs. (2.20±0.52) mg/L, and (304.64±62.25) ng/L vs. (409.46±83.57) ng/L], with statistical differences (t=165.87, 3.56, 6.75; all P<0.05). Conclusion　Tovaptan combined with hydrochlorothiazide is effective in the treatment of refractory edema in patients with NS, and can improve their renal function, promote urination, reduce their body weight, and stabilize electrolyte balance.

Key words:

Nephrotic syndrome, Refractory edema, Hydrochlorothiazide, Tovaptan, Curative effect

摘要：

目的　探讨托伐普坦联合氢氯噻嗪在肾病综合征（NS）患者顽固性水肿中的应用效果。方法　通过前瞻性研究方式，依随机数字表法将聊城市第三人民医院2021年2月至2022年12月收治的90例NS患者分为常规组与研究组，各45例。常规组女15例，男30例，年龄28～67（49.02±5.14）岁；病程6～32（15.59±4.36）个月；水肿程度：中度29例，重度16例；24 h尿量（698.04±98.75）ml。研究组女16例，男29例，年龄30～68（48.76±4.98）岁；病程5～33（16.02±4.15）个月；水肿程度：中度27例，重度18例；24 h尿量（703.45±103.45）ml。常规组给予氢氯噻嗪治疗，研究组给予托伐普坦联合氢氯噻嗪治疗，两组均治疗14 d。分析两组临床疗效、水肿消退时间、不良反应、治疗前后体重、肾功能指标［血尿素氮（BUN）、尿白蛋白（Upro）、血肌酐（Scr）］、尿常规［24 h尿量、尿钠、尿钾排泄量］及血清胱抑素C（Cys-C）、Ｎ末端脑钠肽前体（NT-proBNP）、转化生长因子-β（TGF-β）。统计学方法采用χ²检验、t检验。结果　研究组总有效率为91.11%（41/45），高于常规组［73.33%（33/45）］，差异有统计学意义（χ²=4.87，P<0.05）。治疗后研究组体重和水肿消退时间均低于常规组［（62.39±2.87）kg比（67.96±3.62）kg、（9.04±2.24）d比（11.41±3.01）d］，差异均有统计学意义（t=8.09、4.24，均P<0.05）。治疗后研究组BUN、Upro、Scr均低于常规组［（12.46±2.15）mmol/L比（16.46±1.89）mmol/L、（1.29±0.32）g/24 h比（1.88±0.38）g/24 h、（217.24±93.26）mmol/L比（273.48±101.15）mmol/L］，差异均有统计学意义（t=9.37、7.97、2.74，均P<0.05）。治疗后研究组24 h尿量高于常规组［（1 814.58±189.47）ml/24 h比（1 340.86±201.32）ml/24 h］，差异有统计学意义（t=11.50，P<0.05）。治疗后研究组NT-proBNP、Cys-C、TGF-β均低于常规组［（5 140.29±25.89）ng/L比（6 128.56±30.45）ng/L、（1.87±0.34）mg/L比（2.20±0.52）mg/L、（304.64±62.25）ng/L比（409.46±83.57）ng/L］，差异均有统计学意义（t=165.87、3.56、6.75，均P<0.05）。结论　托伐普坦联合氢氯噻嗪治疗NS患者顽固性水肿疗效显著，能改善肾功能，促进排尿，减轻体重，稳定电解质平衡。

关键词:

肾病综合征, 难治性水肿, 氢氯噻嗪, 托伐普坦, 疗效