目的：观察并探讨托伐普坦治疗乙肝肝硬化失代偿期稀释性低钠血症的临床疗效与安全性。方法：选择2015年5月至2016年10月收治的92例失代偿乙型肝炎肝硬化患者为研究对象，据随机数字表分为治疗组(47例)和对照组(45例)，对照组予常规治疗并螺内酯、氢氯噻嗪联合利尿，治疗组予常规治疗并口服托伐普坦利尿，疗程7 d，记录两组治疗3，5，7 d后血Na+达标比例、24 h尿量及治疗前后肝肾功能变化，比较两组药物不良反应。结果：治疗组治疗3，5，7 d后血Na+达标比例与24 h尿量均显著高于对照组，差异均有统计学意义(P<0.05)。治疗7 d后两组肝功能较治疗前明显改善(P<0.05)，肾功能无明显变化；两组治疗后肝肾功能指标差异无统计学意义(P>0.05)。两组口渴(8.5% vs 6.7%)、尿频(2.1% vs 2.2%)、头晕(2.1% vs 4.4%)等不良反应发生率相近(P>0.05)，治疗组有1例服药5 d后血Na+明显升高伴尿量显著增加而停药。结论：乙肝肝硬化稀释性低钠血症患者在常规治疗基础上加服托伐普坦可显著增加尿量，恢复血Na+浓度，不良反应较轻，可以控制。
Effect of tolvaptan in treatment of diluted hyponatremia for patients with decompensated hepatitis B cirrhosis
Objective: To observe and explore the clinical efficacy and safety of tolvaptan in treatment of decompensated hepatitis B cirrhosis induced diluted hyponatremia. Methods: Ninety-two cases of decompensated hepatitis B cirrhosis patients from May 2015 to October 2016 were enrolled in the study and were randomized into treatment group (47 cases) and control group (45 cases) according to the random number, patients in control group were treated with conventional therapy and spironolactone plus hydrochlorothiazide treatment, the treatment group received conventional therapy and tolvaptan treatment, 7 days for a treatment course, blood Na+ concentration, 24 h urine volume after treatment for 3, 5, 7 d and variations of liver and renal function before and after treatment of the two groups were compared; besides, adverse reactions were noted. Results: After treatment for 3, 5, 7 d, blood Na+ concentration and 24 h urine volume of treatment group were all significantly higher than the control group, the differences between groups with statistical significance (P<0.05). After 7 d treatment, the liver function of the two groups were significantly improved compared with pretreatment (P<0.05), and no significant variation in renal function. There were no significant differences in liver and renal function between the two groups after 7d treatment (P>0.05). Two groups with incidences of thirst (8.5% vs 6.7%), frequent micturition (2.1% vs 2.2%), dizziness (2.1% vs 4.4%) were similar (P>0.05). The treatment group had 1 case suspend medication for blood Na+ concentration and urine volume increased significantly after 5 d treatment. Conclusion: Based on conventional therapy for decompensated hepatitis B cirrhosis induced dilution hyponatremia patients, tolvaptan added can significantly increase urine volume and blood Na+ concentration, and adverse drug reactions can be controllable.