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Фармакотерапия отеков при циррозе печени и хронической сердечной недостаточности: фокус на петлевые диуретики
Фармакотерапия отеков при циррозе печени и хронической сердечной недостаточности: фокус на петлевые диуретики
Кетова Г.Г., Попов А.Ю., Бабич А.Э., Лучинина
Е.В. Фармакотерапия отеков при циррозе печени и хронической сердечной
недостаточности: фокус на петлевые диуретики. Consilium Medicum. 2018;
20 (1): 79–83. DOI: 10.26442/2075-1753_2018.1.79-83
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Аннотация
В статье рассмотрены общность и различие патогенеза отечного синдрома при хронической сердечной недостаточности и циррозе печени, точки приложения разных подгрупп диуретиков. В реальной клинической практике недостаточно используются режим ограничения потребления соли и возможности применения спиронолактона, эплеренона и ацетазоламида. Торасемид является более востребованным диуретиком в сравнении с фуросемидом в связи с лучшим фармакодинамическим профилем и уровнем безопасности. Торасемид – это лекарственное средство с антиальдостероновым и антигипертензивным свойствами, обладающее дозозависимым диуретическим эффектом. В дозировках 2,5–5 мг оказывает преимущественно антигипертензивное и антиальдостеровое действие со слабым натрийуретическим эффектом, что позволяет использовать торасемид для ежедневной постоянной терапии артериальной гипертензии. В средних дозах 5–20 мг наиболее часто применяется для лечения отечного синдрома как в качестве монотерапии, так и в комбинации с другими диуретическими препаратами за исключением петлевых диуретиков. Антиальдостероновый механизм, в основе которого лежит способность торасемида блокировать альдостероновые рецепторы в почках, сердце и снижать секрецию альдостерона надпочечниками, обеспечивает замедление процессов ремоделирования сердца при хронической сердечной недостаточности и позитивные эффекты для лечения отеков разного генеза.
Ключевые слова: отеки, цирроз печени, хроническая сердечная недостаточность, артериальная гипертензия, петлевые диуретики, фуросемид, торасемид.
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The article covers similarities and differences of edema syndrome pathogenesis in congestive heart failure and hepatic cirrhosis as well as sites of action of different diuretics types. The regimen of salt restriction and such medications as spironolactone, eplerenone and acetazolamide are not widely used in everyday clinical practice. Compared with furosemide, torasemide is a more popular diuretic because of better pharmacodynamics profile and safety. Torasemide is a pharmacologic agent with anti-aldosterone and antihypertensive effects. It also has dose-related diuretic effect. When used in dosage of 2.5–5 mg it predominantly has antihypertensive and anti-aldosterone effects with weak natriuretic action that allows its use in everyday hypertension therapy. In medium dosage of 5–20 mg it is more often used in edema syndrome treatment whether in monotherapy or in combination with other diuretics except for loop diuretics. The anti-aldosterone mechanism is based on torasemide ability to block aldosterone receptors in kidneys and heart and lower aldosteron secretion in adrenal glands. It allows to slow down remodeling processes of heart muscle in patients with congestive heart failure and explains positive effects in edema of different genesis management.
Key words: edema, hepatic cirrhosis, congestive heart failure, hypertension, loop diuretics, furosemide, torasemide.
Полный текст
Список литературы
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6. Lechenie astsita, oslozhniaiushchego tsirroz pecheni u vzroslykh. Prakticheskoe rukovodstvo Vsemirnogo gastroenterologicheskogo obshchestva (VGO). Ros. zhurn. gastroenterologii, gepatologii i koloproktologii. 2007; 17 (4): 82–8. [in Russian]
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8. Gosse P, Sheridan DJ, Zannad F et al. Regression of left ventricular hypertrophy in hypertensive patients treated with indapamide SR 1.5 mg versus enalapril 20 mg: the LIVE study. Hypertens 2000; 18: 1465–75.
9. Medical research counsil working party. MRC trial of treatment of mild hypertension: principal results. BMJ 1985; 291: 97–104.
10. The ALLHAT officers and coordinators for the ALLHAT collaborative research group. Major outcomes in high – risk hypertensive patients randomized to angiotensin – converting enzyme inhibitor or calcium channel blocker vs diuretic. JAMA 2002; 288: 2981–97.
11. Neaton JD, Grimm RH, Prineas RJ et al. Treatment of mild hypertension study. JAMA 1993; 270: 713–24.
12. Dahlof B, Lindholm LH, Hansson L et al. Morbidity and mortality in the Swedish Trial in Old Patients with hypertension (STOP – Hypertension). Lancet 1991; 338: 1281–5.
13. Marre M, Puig JG, Kokot F et al. Equivalence of indapamide SR and enalapril on microalbuminuria reduction in hypertensive patients with type 2 diabetes: the NESTOR study. Hypertens 2004; 22: 1613–22.
14. Ponomareva A.I., Kompaniets O.G., Averin E.E. Novye vozmozhnosti farmakoterapii arterial'noi gipertenzii. RMZh. Kardiologiya. 2012; 25 (20): 1–6. [in Russian]
15. Ponomareva A.I., Ketova G.G., Kompaniets O.G. Clinical-pharmacological priorities in the election of blockators of the renin-angiotenzine system and diuretics in patients with uncompleted hypertension. Systemic Hypertension. 2017; 14 (2): 75–9. DOI: 10.26442/2075-082X_14.2.75-79 [in Russian]
16. Linchak R.M. Sravnitelnaia effektivnost fiksirovannoi kombinatsii perindopril/indapamid u bolnykh arterialnoi gipertenziei razlichnogo pola i vozrasta. Kardiologiia. 2010; 50 (6): 35–40. [in Russian]
17. Linchak R.M., Shumilova K.M., Martyniuk A.D. i dr. Primenenie kombinirovannogo preparata lozartana i gidrokhlortiazida v antigipertenzivnoi terapii. Ratsion. farmakoterapiia v kardiologii. 2006; 2 (1): 18–26. [in Russian]
18. Uchida T, Yamanaga K, Nishikawa M et al. Anti-aldosteronergic effect of torasemide. Eur J Pharmacol 1991; 205: 145–50.
19. Goodfriend TL, Ball DL, Oelkers W et al. Torasemide inhibits aldosterone secretion in vitro. Life Sci 1998; 63: 45–50.
20. Domanski M, Norman J, Pitt B et al. Diuretic use, progressive heart failure, and death in patients in the Studies of Left Ventricular Dysfunction (SOLVD). J Am Coll Cardiol 2003; 42: 705–8.
21. Gosudarstvennyi reestr lekarstvennykh sredstv. http:www.grls.rosminzdrav.ru [in Russian]
22. Murray MD, Deer MM, Ferguson JA et al. Open-label randomized trial of torasemide compared with furosemide therapy for patients with heart failure. Am J Med 2001; 111: 513–20.
23. Cosín J, Díez J. TORIC investigators. Torasemide in chronic heart failure: results of the TORIC study. Eur J Heart Fail 2002; 4: 507–13.
24. Vargo DL, Kramer WG, Black PK et al. Bioavailability, pharmacokinetics, and pharmacodynamics of torsemide and furosemide in patients with congestive heart failure. Clin Pharmacol Ther 1995; 57: 601–9.
25. Harada K et al. Beneficial Effects of Torasemide on Systolic Wall Stress and Sympathetic Nervous Activity in Asymptomatic or Mildly Symptomatic Patients With Heart Failure: Comparison With Azosemide. J Cardiovasc Pharmacol 2009; 53: 468–73.
26. Yamato M, Sasaki T, Honda K et al. Effects of torasemide in left ventricular function and neurohumoral factors in patients with chronic heart failure. Circ J 2003; 67 (5): 384–90.
27. Mуller K, Gamba G, Jaquet F, Hess B. Torasemide vs. furosemide in primary care patients with chronic heart failure NYHA II to IV – efficacy and quality of life. Eur J Heart Fail 2003; 5 (6): 793–801.
28. Ponomareva A.I., Kompaniets O.G., Linchak R.M. et al. Pharmacoepidemiological study of recommendations of diuretics for the treatment of hypertension in the outpatient setting. Systemic Hypertension. 2014; 3: 48–53. [in Russian]
29. Lopez B, Gonzalez A, Hermida N et al. Myocardial fibrosis in chronic kidney disease: potential benefits of torasemide. Kidney Int 2008; 111: 19–23.
30. Coca A. Effect of torasemide in monotherapy or associated to other antihypertensive drugs on pulse pressure in essential hypertension. Amer J Hypertens 2002; 15: 113–4.
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Авторы
Г.Г.Кетова1, А.Ю.Попов2, А.Э.Бабич*2, Е.В.Лучинина3
1 ФГБОУ ВО «Южно-Уральский государственный медицинский университет» Минздрава России. 454092, Россия, Челябинск, ул. Воровского, д. 64;
2 ГБУЗ «Научно-исследовательский институт – Краевая клиническая больница №1 им. проф. С.В.Очаповского» Минздрава Краснодарского края. 350029, Россия, Краснодар, ул. 1 Мая, д. 16;
3 ФГБОУ ВО «Саратовский государственный медицинский университет им. В.И.Разумовского» Минздрава России. 410012, Россия, Саратов, ул. Большая Казачья, д. 112
________________________________________________
G.G.Ketova1, A.Yu.Popov2, A.E.Babich*2, E.V.Luchinina3
1South Ural State Medical University of the Ministry of Health of the Russian Federation. 454092, Russian Federation, Chelyabinsk, ul. Vorovskogo, d. 64;
2S.V.Ochapovsky Clinical Hospital №1 of the Ministry of Health of the Krasnodar Region. 350029, Russian Federation, Krasnodar, ul. 1 Maia, d. 16;
3V.I.Razumovsky Saratov State Medical University of the Ministry of Health of the Russian Federation. 410012, Russian Federation, Saratov, ul. Bol'shaia Kazach'ia, d. 112
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