中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

西地那非联合波生坦治疗结缔组织病相关中重度肺动脉高压的临床疗效

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目的 探讨西地那非联合波生坦治疗结缔组织病相关中重度肺动脉高压(CTD-MS-PAH)的临床疗效及安全性。 方法 收集 2013 年 1 月至 2017 年 1 月在湖北医药学院附属人民医院及太和医院就诊的 CTD-MS-PAH 患者 76 例,分层随机分为 A 组(41 例)和 B 组(35 例)。A 组给予西地那非片 25 mg,3 次/d;B 组给予西地那非片 25 mg 联合波生坦片 62.5 mg,均为 2 次/d。治疗 12 周后,将两组患者治疗前后的 6 分钟步行距离(6MWD)、Borg 呼吸困难指数评分、肺动脉收缩压(PASP)、右心室前后径(RVD)、血清脑钠肽(BNP)、动脉氧分压(PaO2)、血压、心率、肝肾功指标进行比较。 结果 与治疗前比较,治疗后 A、B 两组患者 6MWD 延长,Borg 呼吸困难指数评分降低,PASP、RVD、BNP 下降,PaO2 升高(均 P<0.05),但 B 组指标改善程度更优(均P<0.05),差异均有统计学意义。A、B 两组治疗前后的血压、心率、肝肾功能均无显著差异(均P>0.05)。 结论 西地那非联合波生坦能显著降低肺动脉压,有效改善 CTD-MS-PAH 患者的心肺功能,且具有较好的安全性。

Objective To explore the clinical effect and safety of sildenafil combined with bosentan in the treatment of connective tissue disease associated moderate-severe pulmonary arterial hypertension (CTD-MS-PAH ). Methods Seventy-six patients with CTD-MS-PAH during January 2013 to January 2017 were collected and divided into group A (41 cases) and group B (35 cases) using a stratified random sampling approach. The patients in group A received 25 mg sildenafil tablet therapy, three times a day. The patients group B received 25 mg sildenafil and 62.5 mg bosentan tablet therapy, twice a day. Both groups were treated for 12 weeks. Before and after the trial, all patients undertook six-minute walk test. Meanwhile the Borg dyspnea index score, the pulmonary artery systolic pressure (PASP), right ventricular diameter (RVD), B-type natriuretic peptide (BNP), the partial pressure of oxygen in artery (PaO2), blood pressure, heart rate, liver and kidney function were all measured. Results After the therapy, six-minute walking distance increased, Borg dyspnea index score decreased, PASP, RVD and plasma BNP decreased, and PaO2 increased in both groups (all P<0.05), but group B was superior to group A (allP<0.05). There were no significant differences in blood pressure, heart rate, liver or kidney function compared with those before the treatment in both groups (allP>0.05). Conclusion Sildenafil combined with bosentan can significantly decrease the level of pulmonary arterial pressure and effectively improve the cardiopulmonary function in CTD-MS-PAH patients with good safety.

关键词: 肺动脉高压; 结缔组织病; 西地那非; 波生坦

Key words: Pulmonary arterial hypertension; Connective tissue disease; Sildenafil; Bosentan

引用本文: 朱建勇, 曾玉琴, 胡清, 徐萍. 西地那非联合波生坦治疗结缔组织病相关中重度肺动脉高压的临床疗效. 中国呼吸与危重监护杂志, 2018, 17(4): 369-372. doi: 10.7507/1671-6205.201711045 复制

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