International Journal of Clinical Research
International Journal of Clinical Research. 2026; 10: (9) ; 10.12208/j.ijcr.20260438 .
总浏览量: 19
1大理大学临床医学院 云南昆明
2大理大学第二附属医院 云南昆明
*通讯作者： 郑盛,单位：大理大学第二附属医院 云南昆明; ；
腹水是肝硬化失代偿期最常见的并发症，约60%的代偿期患者10年内出现腹水，一旦发生则5年生存率降至30%-40%。利尿剂是腹水治疗的一线基础药物，近年来在药物选择、联合方案及反应性评估等方面取得重要进展。本文系统综述了醛固酮受体拮抗剂（螺内酯、依普利酮）、袢利尿剂（呋塞米、托拉塞米、布美他尼）及血管加压素V2受体拮抗剂（托伐普坦）的作用机制、药代动力学特征和临床疗效，比较了中国、欧洲、美国及日本指南的用药方案差异，探讨了尿钠排泄量、UNa/K比值等反应性评估指标的应用价值，并分析了电解质紊乱、肾损伤、肝性脑病等不良反应的防治策略，为肝硬化腹水的个体化利尿剂治疗提供循证参考。
Ascites is the most common complication of decompensated cirrhosis. Approximately 60% of patients with compensated cirrhosis develop ascites within 10 years, and the 5-year survival rate declines to 30%-40% once ascites occurs. Diuretics serve as first-line foundational agents for the management of ascites, and important advances have been achieved in recent years regarding drug selection, combination regimens and responsiveness assessment. This article systematically reviews the mechanisms of action, pharmacokinetic profiles and clinical efficacy of aldosterone receptor antagonists (spironolactone, eplerenone), loop diuretics (furosemide, torasemide, bumetanide), and vasopressin V2 receptor antagonists (tolvaptan). It compares discrepancies in medication regimens recommended by Chinese, European, American and Japanese clinical guidelines, explores the practical value of responsiveness biomarkers including urinary sodium excretion and urinary sodium/potassium ratio (UNa/K), and analyzes prevention and management strategies for adverse reactions such as electrolyte disturbances, renal injury and hepatic encephalopathy. This review provides evidence-based references for individualized diuretic therapy in patients with cirrhotic ascites.
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