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간경변성 복수 환자에서 Vaptan계열 약제의 유용성

Efficacy of Vaptans for Management of Ascites in Patients with Liver Cirrhosis

이준성|최원혁
대한내과학회 (The Korean Association Of Internal Medicine)|2012.01|대한내과학회지 (The Korean Journal of Medicine)|제82권 제1호|pp. 22-31

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참고문헌

키워드

복수간경변증Hyponatremia저나트륨혈증AscitesLiver cirrhosisVasopressin바소프레신밥탄계 약제유리수분 배출AquaresisVaptans
주제분류내과학

초록

간경변증 환자에서 복수와 저나트륨혈증 발생의 병태생리학적 과정은 다양한 요소가 작용하지만, 이들 과정 중 AVP의 증가가 복수, 저나트륨혈증 발생 모두에 있어 중요한 요인으로 추정되고 있다. 하지만 AVP 수용체 길항제인 vaptan계열 약제의 임상연구 결과에서 저나트륨혈증 치료제로는 뚜렷한 임상 효과를 보이는 반면, 간경변성 복수 치료제로써의 연구 결과는 매우 부족하거나, 일부 결과는 미흡한 치료성적을 보여주고 있다. 그럼에도 불구하고 상당수 간경변성 복수 환자는 현재의 표준 치료에 한계가 있으며, vaptan계열 약제 등 새로운 치료제의 도움이 필요한 상황이다. 아직까지 어느 시점에서 어떤 환자를 대상으로, 어느 정도의 적정 용량으로, 얼마만큼의 기간 동안 투약하고 치료해야 할지에 대한 자료가 매우 부족한 실정이며, 향후 이에 대한 추가적인 임상연구가 기대된다.

Abstract

Ascites is the most common complication of liver cirrhosis, but its pharmacological management is unsatisfactory in some patients because of a lack of response to treatment with conventional diuretics. Patients with cirrhosis and ascites generally have increased non-osmotic secretion of vasopressin which participates in the pathogenesis of fluid retention. Vaptans are a new family of orally active drugs that increase urine volume by antagonizing specifically the vasopressin receptors in the principal cells of the collecting ducts that have been shown to correct dilutional hyponatremia effectively. They also seem to be promising in the management of ascites by reducing the increased extracellular fluid volume in conditions associated with water retention including liver cirrhosis. However, there is a paucity of information on whether vaptans might have beneficial effect in enhancing ascites reduction in patients with cirrhosis. This review addresses the pharmacological actions of vaptans, their clinical applications, and future potential roles in managing patients with liver cirrhosis and ascites. (Korean J Med 2012;82:22-31)

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