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两种常用剂量的托伐普坦对高龄老年慢性心衰患者预后的影响

摘要:背景 托伐普坦在老年慢性心衰患者中应用广泛,但7.5mg/天和15mg/天两种剂量的托伐普坦对心衰预后的影响是否存在差别尚不明确。目的 探讨两种常用剂量的托伐普坦对高龄老年慢性心衰患者预后的影响。方法 回顾性分析2016年2月-2022年2月于解放军第九六〇医院保健病房进行治疗,且应用了托伐普坦药物的高龄老年慢性心衰患者212例,按应用剂量分为7.5mg/天和15mg/天组。比较两组患者基线特征、合并疾病、合并用药及实验室检查指标,绘制Kaplan-Meier生存曲线,比较两组患者全因死亡及心血管死亡的差异,并采用多因素Cox比例风险回归模型分析两种剂量托伐普坦对终点事件的影响。结果 共纳入212例高龄老年慢性心衰患者,随访374.5 (155.5, 940.5)天,共发生全因死亡124例(58.5%)和心血管死亡53例(25%),Kaplan-Meier生存分析比较,托伐普坦15mg/d组全因死亡率和心血管死亡率均高于托伐普坦7.5mg/d组(P=0.0043,P=0.0012)。多因素Cox比例风险回归模型分析显示,校正了年龄、NYHA心功能分级、慢性肾脏疾病、糖尿病、高血压、冠心病、利尿剂、ALB、NT-proBNP与eGFR,与7.5mg/d组相比,15mg/d组全因死亡和心血管死亡风险分别增加1.03倍和1.51倍(HR=2.03,95%CI: 1.34-2.99)和HR=2.51,95%CI: 1.4-4.5)。在对eGFR、年龄、白蛋白、NT-pro BNP分层后,托伐普坦15mg/d组与全因死亡和心血管死亡的风险增加仍相关。结论 在高龄老年慢性心衰患者中,托伐普坦15mg/d比托伐普坦7.5mg/d全因死亡和心血管死亡风险增加,推荐使用低剂量托伐普坦。

英文摘要:Background Tolvaptan is widely used in elderly patients with chronic heart failure, but it is unclear whether there is a difference in the prognosis of heart failure between the two doses of 7.5 mg/day and 15 mg/day of tolvaptan.Objective To investigate the effect of two commonly used doses of tolvaptan on the prognosis of elderly patients with chronic heart failure. Methods 212 elderly patients with chronic heart failure were retrospective analyzed, who were continuously treated in the health care ward of the 960th Hospital of the People's Liberation Army from February 2016 to February 2022, and According to the applied tolvaptan dose (7.5mg/day or15mg/day), these patients were divided into two groups. Baseline characteristics, co-morbidities, combined medications and laboratory test indexes were compared between the two groups, Kaplan-Meier survival curves were plotted to compare the differences in all-cause mortality and cardiovascular death, and the effects of different doses of tolvaptan on endpoint events were analyzed using a multifactorial Cox proportional risk regression model. Results A total of 212 elderly patients with chronic heart failure were included and followed for 374.5 (155.5, 940.5) days, with a total of 124 (58.5%) all-cause deaths and 53 (25%) cardiovascular deaths, and Kaplan-Meier survival analysis compared all-cause and cardiovascular mortality in the 15mg/day tolvaptan group to the 7.5mg/day tolvaptan group, The difference was statistically significant (P= 0.0043, P=0.0012). Analysis of the adjusted multifactorial Cox proportional risk regression model showed that after adjusting for age, NYHA cardiac function class, CKD, Diabetes, Hypertention, CHD, diuretics, ALB, and NT-proBNP and eGFR, the risk of all-cause mortality and cardiovascular mortality increased 1.03-fold and 1.51-fold, respectively, in the 15mg/day group compared with the 7.5mg/day group(HR=2.03,95%CI: 1.34-2.99 and HR=2.51,95%CI: 1.4-4.5). After stratification for eGFR, age, albumin, and NT-proBNP, the tolvaptan 15mg/day group remained significantly associated with the risk of all-cause mortality and cardiovascular death. Conclusion In elderly patients with chronic heart failure, all-cause mortality and cardiovascular mortality risks are increased with 15mg/day tolvaptan compared with 7.5mg/day tolvaptan, which is recommended.

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[V1] 2022-08-12 18:31:10 chinaXiv:202208.00083V1 下载全文
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