Efecto de los antagonistas selectivos del receptor de vasopresina V2 en pacientes con cirrosis hepática con ascitis: un metanálisis

OBJECTIVE:

To evaluate the efficacy and safety of selective vasopressin V2 receptor antagonists in the treatment of hepatic cirrhosis patients with ascites.

METHODS:

PubMed, EMBASE, Web of Science, The Cochrane Central Register of Controlled Trials, Database for Chinese Technical Periodical (VIP), Chinese Journal Full-Text Database (CNKI), and Wan Fang Digital Journal Full-text Database were retrieved to collect clinical randomized controlled trials of hepatic cirrhosis with ascites treated by selective vasopressin V2 receptor antagonists. Meta analysis was performed by using Review Manager 5.0.

RESULTS:

Nine randomized controlled trials including 1884 patients met the inclusion criteria. Meta-analysis showed that: 1) The selective vasopressin V2 receptor antagonists were associated with a significant reduction in body weight compared with placebo (WMD=–1.98kg, 95%CI:–3.24-–0.72kg, P=0.002). Treatment with selective vasopressin V2 receptor antagonists was associated with an improvement of low serum sodium concentration compared to placebo (WMD=3.74mmol/L, 95%CI: 0.91-6.58mmol/L, P=0.01). The percentage of patients with worsening ascites was higher in the group of patients treated with placebo (RR=0.51, 95%CI: 0.34-0.77, P=0.001). 2) The amplitude of increased urine volume was obviously higher in selective vasopressin V2 receptor antagonists group than in placebo group (WMD=1437.65ml, 95%CI: 649.01-2226.30ml, P=0.0004). The difference of serum creatinine in the selective vasopressin V2 receptor antagonists group was not statistically significant compared with the control group (WMD=–3.49μmol/L, 95%CI: –12.54¬5.56μmol/L, P=0.45). 3) There was no statistical significance between the two groups in the heart rate, systolic pressure, diastolic pressure and mortality (P>0.05). The rate of other adverse reactions was higher in the selective vasopressin V2 receptor antagonists group compared with that of placebo group (P=0.003).

CONCLUSION:

The selective vasopressin V2 receptor antagonists may improve ascites and increase serum sodium in patients with hepatic cirrhosis and ascites. No significant changes are observed in heart and kidney function, and the incidence of adverse reaction is relatively less. It could be a novel therapy for the treatment of ascites due to liver cirrhosis.