Usefulness of portal vein pressure for predicting the effects of tolvaptan in cirrhotic patients

作     者：Ai Nakagawa Masanori Atsukawa Akihito Tsubota Chisa Kondo Tomomi Okubo Taeang Arai Norio Itokawa Yoshiyuki Narahara Katsuhiko Iwakiri 

作者机构：Division of Gastroenterology Department of Internal Medicine Nippon Medical School Chiba Hokusoh Hospital Core Research Facilities for Basic Science Research Center for Medical Sciences Jikei University School of Medicine Division of Gastroenterology Department of Internal Medicine Nippon Medical School 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2016年第22卷第21期

页      面：5104-5113页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：Japan Society for the Promotion of Science  JSPS  (15K06810) 

主　　题：Tolvaptan V₂ receptor antagonist Portal vein pressure Hepatic venous pressure gradient Decompensated chirrosis 

摘      要：AIM: To elucidate influencing factors of treatment response, then tolvaptan has been approved in Japan for liquid ***: We herein conducted this study to clarify the influencing factors in 40 patients with decompensated liver cirrhosis complicated by liquid retention. Tolvaptan was administered at a dosage of 7.5 mg once a day for patients with conventional diuretic-resistant hepatic edema for 7 d. At the initiation of tolvaptan, the estimated hepatic venous pressure gradient (HVPG) value which was estimated portal vein pressure was measured using hepatic venous catheterization. We analyzed the effects of tolvaptan and influencing factors associated with treatment ***: Subjects comprised patients with a median age of 65 (range, 40-82) years. According to the Child-Pugh classification, class A was 3 patients, class B was 19, and class C was 18. Changes from the baseline in body weight were -1.0 kg (P = 2.04 × 10-6) and -1.3 kg (P = 1.83 × 10-5), respectively. The median HVPG value was 240 (range, 105-580) mmH2O. HVPG was only significant influencing factor of the weight loss effect. When patients with body weight loss of 2 kg or greater from the baseline was defined as responders, receiver operating characteristic curve analysis showed that the optimal HVPG cutoff value was 190 mmH2O in predicting treatment response. The response rate was 87.5% (7/8) in patients with HVPG of 190 mmH2O or less, whereas it was only 12.5% (2/16) in those with HVPG of greater than 190 mmH2O (P = 7.46 × 10-4). We compared each characteristics factors between responders and non-responders. As a result, HVPG (P = 0.045) and serum hyaluronic acid (P = 0.017) were detected as useful ***: The present study suggests that tolvaptan in the treatment of liquid retention could be more effective for patients with lower portal vein pressure.