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  

Clinical effect of sildenafil combined with bosentan in treatment of connective tissue disease associated moderate-severe pulmonary arterial hypertension

作　　者：朱建勇 曾玉琴[2] 胡清[2] 徐萍 ZHU Jianyong;ZENG Yuqin;HU Qing;XU Ping(Department of Respiratory Medicine, Renmin Hospital Affiliated to Hubei University of Medicine, Shiyan, Hubei 442000, P. R. China;Department of Endocrine and Rheumatism Diseases, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan, Hubei 442000, P. R. China;Department of Rheumatism Diseases, Renmin Hospital Affiliated to Hubei University of Medicine, Shiyan, Hubei 442000, P. R. China)

机构地区：[1]湖北医药学院附属人民医院呼吸科,湖北十堰442000 [2]湖北医药学院附属太和医院内分泌风湿科,湖北十堰442000 [3]湖北医药学院附属人民医院风湿科,湖北十堰442000

出　　处：《中国呼吸与危重监护杂志》2018年第4期369-372,共4页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：湖北省教育厅科学技术研究项目(B2014043)

摘　　要：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(Pa O2)、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,Pa O2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 received25 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 sixminute 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（Pa O2）, 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 Pa O2 increased in both groups（all P〈0.05）, but group B was superior to group A（all P〈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（all P〈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 

分 类 号：R544.1[医药卫生—心血管疾病] R593.2[医药卫生—内科学]