Effect And Safety Of Oral Tolvaptan Treatment In Liver Cirrhosis Patients With Ascites Complicated By Hyponatremia

Objective: Serum sodium level, which is regulated by neuroendocrinesystem, is an important factor to maintain body fluid volume and osmoticpressure， thus maintaining homeostasis and normal physiological function.Sodium balance disorder can lead to a series of symptoms, the mildmanifesting as fatigue and muscle tension abated, while the severe beingcognitive and motion dysfunction, and even coma.Liver cirrhosis ascites is often complicated with hyponatremia. Thetreatment of hyponatremia will affect the prognosis of the disease. Withdecrease of serum sodium level, the mortality of patients increases. So theliver cirrhosis with ascites complicated by hyponatremia is attached moreand more importance.The treatment of liver cirrhosis ascites complicated with hyponatremiahas been a difficult problem. The reason is that although diuretics is aneffective drug for the treatment of liver cirrhosis ascites, but a lot of sodiumions is lost by diuretics, and the release of antidiuretic hormone is promotedby it. These leads to more water retention and osmotic pressure decline. Inaddition, because of the sodium ion deficiency and diuretic lost target ion,the diuretic effect is weakened. Continuous use of diuretics not only makesit difficult to achieve diuretic effect, but also makes the hyponatremia andwater retention aggravated. So the correction of hyponatremia has taken akey role on ascites treatment. Traditional method of treatment is restrictingfluid intake, but this method has little effect. Vaptans is a new drug to treatliver cirrhosis ascites complicated with hyponatremia. Tolvaptan is a kindof Vaptans, and it is a selective vasopressin V2receptor antagonist. It works mainly through the inhibition of renal tubular V2receptor and antidiuretichormone combination, thus increasing serum sodium levels and removingexcess water in vivo.Observe the curative effect and safety of tolvaptan tablets on livercirrhosis ascites complicated with hyponatremia.Methods:82patients with liver cirrhosis ascites complicated withhyponatremia conforming to the experimental standard were included. Allof them were randomly divided into tolvaptan therapy group (42cases) andconventional therapy group (40cases), and were treated for a total of sevendays. The treatment of tolvaptan group was taken tolvaptan tablets, limitedsodium ion intake and not restricted water intake. The treatment ofconventional therapy group was limiting water intake. The water intakeshould be controlled in1-1.5L/d, and according to the specific situationdeciding application of the diuretic, the sodium and albumin weresupplemented. The serum sodium, serum potassium, urine volume, bodyweight, heart rate, blood pressure and other parameters in patients oftolvaptan group and conventional therapy group before and after seven daysof treatments were compared. Each group’s adverse events in the course oftreatment were recorded, to understand the safety of tolvaptan.Results:1.Before the start of the treatment, the serum sodium concentration oftolvaptan group and conventional treatment group were129.76±5.16mmol/L and130.51±5.21mmol/L respectively, and there was noobvious difference (P>0.05). At the fifth and eighth day after the start ofthe treatment, the serum sodium levels of tolvaptan group were134.92±6.47mmol/L and139.21±6.87mmol/L, and the conventional treatmentgroup’s were131.40±5.83mmol/L and131.80±5.95mmol/L, with obviousdifferences between the two groups (P <0.05).2.Before the start of the treatment, urinary production of tolvaptangroup and conventional treatment group were1298.3±512.7ml and1304.6±697.3ml, there was no obvious difference (P>0.05). At the fourthand seventh day after the start of the treatment, the urinary productions oftolvaptan group’s were2169.7±611.6ml and3058.3±706.4ml, and there in the conventional treatment group were1681.9±576.5ml and1749.1±604.7ml, with obvious differences between two groups (P <0.05).3. At the fifth and eighth day after the start of the treatment, the amountof weight reduction of tolvaptan group were1.25±0.55kg and2.06±0.47kg,and the amount of weight reduction of the conventional treatment groupwere0.82±0.48kg and1.02±0.53kg, there existed differences between twogroups (P <0.05).4.Before the start of the treatment, serum potassium concentration oftolvaptan group and conventional treatment group were3.42±0.66mmol/Land3.57±0.49mmol/L, there was no obvious difference (P>0.05). At thefifth and eighth day after the start of the treatment, tolvaptan group’s serumsodium concentration were3.64±0.59mmol/L and3.81±0.56mmol/L, andthe conventional treatment group’s were3.48±0.54mmol/L and3.64±0.43mmol/L, there existed no obvious differences between two groups(P>0.05).5.Before the start of the treatment, heart rate of tolvaptan group andconventional treatment group were67±6.3and68±7beats/min, there wasno obvious difference (P>0.05). At the eighth day after the start of thetreatment, heart rate of tolvaptan group and conventional treatment groupwere67±7.2and69±9beats/min, there exist no obvious differencesbetween two groups (P>0.05).6.Before the start of the treatment, blood pressure of tolvaptan groupand conventional treatment group were115±7.9/78±5.3mmhg and119±6.3/80±6.1mmhg, there was no obvious difference (P>0.05). At theeighth day after the start of the treatment, blood pressure of tolvaptan groupand conventional treatment group were118±7.7/79±6.0mmhg and117±8.0/79±6.4mmhg, there exist no obvious differences between twogroups (P>0.05).7. In tolvaptan group thirsty occurred in25cases, dry mouth occurred in10cases, but the degree was mild, and had been lasted for several hours totwo days. Patients with these symptoms improved obviously after drinkingwater. There was no other adverse reactionConclusion: Tolvaptan can efficaciously improve the serum sodium concentration increase urinary production and reduce weight compared withconventional treatment. At the same time there is no obvious effect onserum potassium concentration, heart rate and blood pressure. Side-effectsof tolvaptan thirst and dry mouth have a high incidence.