安立生坦与波生坦联合西地那非治疗先天性心脏病合并中重度肺动脉高压疗效的对比研究  

Comparative study on the efficacy of alisentan and bosentan combined with sildenafil in the treatment of congenital heart disease with moderate to severe pulmonary hypertension

作　　者：牛力 潘家义 谌晶晶 李伟 NIU Li;PAN Jiayi;CHEN Jingjing;LI Wei(Department of Cardiology,Affiliated Hospital of Guizhou Medical University,Guiyang,550001,China)

机构地区：[1]贵州医科大学附属医院心血管内科,贵阳550001

出　　处：《临床心血管病杂志》2021年第4期346-350,共5页Journal of Clinical Cardiology

基　　金：国家自然科学基金项目(No:81960047);贵州省卫生健康委科学技术基金(No:gzwjkj2018-1-023)。

摘　　要：目的:对比研究安立生坦与波生坦联合西地那非治疗先天性心脏病(CHD)合并中重度肺动脉高压(PAH)的疗效。方法:将我院收治的98例CHD合并中重度PAH患者随机分为安立生坦组(49例)与波生坦组(49例),在常规治疗的基础上,分别行安立生坦联合西地那非治疗、波生坦联合西地那非治疗。评价2组患者的临床疗效;于2组患者治疗前后,检测肺血流动力学指标[肺动脉收缩压(PASP)、肺动脉舒张压(PADP)、平均肺动脉压(MPAP)]、肺功能指标[用力肺活量(FVC)、第一秒用力呼气容积(FEV1)、第一秒用力呼气量占用力肺活量比值(FEV1/FVC)]、心功能指标[6 min步行试验(6MWT)、血清氨基末端脑利钠肽前体(NT-proBNP)、左心室舒张末内径(LVEDD)、右心室舒张末内径(RVEDD)、左心房内径(PAK)]、血清内皮素(ET)-1和血管内皮生长因子(VEGF)。结果:安立生坦组与波生坦组临床治疗总有效率比较,差异无统计学意义(91.84%:85.71%,P>0.05)。在肺血流动力学指标PASP、PADP、MPAP上和肺功能指标FVC、FEV1、FEV1/FVC上,治疗干预前后,安立生坦组与波生坦组比较,差异均无统计学意义(P>0.05)。治疗后,安立生坦组患者6MWT高于波生坦组(P<0.05),血清NT-proBNP低于波生坦组(P<0.05),LVEDD、RVEDD、LAD均低于波生坦组(P<0.05),安立生坦组患者血清ET-1、VEGF均低于波生坦组(P<0.05)。结论:安立生坦联合西地那非治疗CHD合并中重度PAH的疗效要稍优于波生坦联合西地那非,主要与安立生坦联合治疗下对患者心功能、心室重构及肺血管内皮功能的改善效果优于波生坦有关。Objective:To compare the efficacy of alisentan and bosentan combined with sildenafil in the treatment of congenital heart disease(CHD)with moderate to severe pulmonary hypertension(PAH).Methods:The 98 patients with CHD complicated with moderate to severe PAH were randomly divided into two groups,including alisentan group(49 cases)and bosentan group(49 cases).The following indexes were detected before and after treatment:the pulmonary hemodynamic indexes[pulmonary systolic pressure(PASP),pulmonary diastolic pressure(PADP),mean pulmonary artery pressure(mPAP)],pulmonary function indexes[forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),ratio of forced expiratory volume in the first second to forced vital capacity(FEV1/FVC)],cardiac function indexes[Six minute walk test(6 MWT)],serum N-terminal pro brain natriuretic peptide(NT-proBNP),left ventricular end diastolic diameter(LVEDD),right ventricular end diastolic diameter(RVEDD),left atrial diameter(PAK),serum ET-1,and VEGF.Results:The total effective rate was 91.84%in the alisentan group and 85.71%in the bosentan group.There was no significant difference between the two groups(P>0.05).There was no significant difference in PASP,PADP,mPAP,FVC,FEV1,and FEV1/FVC between the two groups before and after treatment(P>0.05).After treatment,6 MWT,NT-proBNP,LVEDD,RVEDD,and LAD in the alisentan group were higher than those in the bosentan group(P<0.05),while ET-1 and VEGF in the alisentan group were lower than those in the bosentan group(P<0.05).Conclusion:The efficacy of alisentan combined with sildenafil is slightly better than that of bosentan combined with sildenafil in CHD with moderate to severe PAH,which is mainly related to the better improvement of cardiac function,ventricular remodeling and pulmonary vascular endothelial function.

关 键 词：先天性心脏病 肺动脉高压 安立生坦 波生坦 西地那非 

分 类 号：R541.1[医药卫生—心血管疾病]