トルバプタンの外来継続はうっ血性心不全患者の長期予後改善と，心不全による再入院回数の減少に関連する

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(Received for publication September 25, 2019)

The efficacy of tolvaptan continuation

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（和文抄録）

トルバプタンの外来継続はうっ血性心不全患者の長期予後改善と，

心不全による再入院回数の減少に関連する

福岡赤十字病院 循環器内科

松 川 龍 一，中 島 涼 亮，豊 原 貴 之，岡 原 有 秀，河 合 俊 輔，

徳 留 正 穀，栗 林 祥 子，松 浦 広 英，増 田 征 剛，向 井

目的：慢性心不全に対するトルバプタンの退院後の長期使用の効果は明らかではなく，この研究では

その効果についての検討を行った．

方法：我々は連続 407 名の入院を必要とするうっ血性心不全患者の退院後 1 年間の予後について検討，

42 名の院内死亡，透析患者を除いた 365 名について解析を行った．

結果：多変量解析を行うと，入院前 1 年間に少なくとも 1 回以上の心不全入院歴のある患者（frequent flyer と定義），高齢であること，貧血があること，男性であること，NPPV による治療を受けた

ことなどが 1 年間の心不全再入院と関連が強い因子として残った．我々は続いて退院後にトルバプタ

ンを継続したことと心不全再入院についての関連について調べた．トルバプタン継続群とそれ以外で，

心不全再入院と関連する交絡因子を含めた背景を揃えるためにプロペンシティマッチングを行い，そ

れぞれ 37 名ずつでの解析を行った．1 年間の心不全再入院回避率はトルバプタン継続群で高い傾向

にあった（p=0.08）．心不全再入院回避率と全死亡回避率を合わせた複合アウトカムはトルバプタン

継続群で有意に高かった（p=0.04）．さらに，対象入院前の 1 年間の心不全入院回数と退院後 1 年間

の再入院回数の変化を比べたところトルバプタン継続群で入院回数の減少率は有意に高かった

（-1.78 ± 1.05 vs. -1.08 ± 0.82, p=0.002）．さらに，59 名の frequent flyer の患者だけで比べても同

様の結果が得られた(-2.31 ± 1.08 vs. -1.43 ± 0.80，p ＜ 0.001）．

結論：これらの結果から退院後のトルバプタン継続はうっ血性心不全患者の長期予後を改善し，心不

全再入院回数を減少させる可能性が示唆された．

キーワード：トルバプタン外来継続，心不全再入院，Frequent flyer

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