环磷酰胺联合波生坦对结缔组织病-肺间质病变合并肺动脉高压患者的临床疗效  

Clinical efficacy of cyclophosphamide combined with bosentan in patients with connective tissue disease associated lung interstitial disease complicated with pulmonary hypertension

作　　者：罗寰[1] 陈苗苗[1] 赵悦 任占芬[1] 杨金良[1] 郑学军[1] 武雪亮[2] Luo Huan;Chen Miaomiao;Zhao Yue;Ren Zhanfen;Yang Jinliang;Zheng Xuejun;Wu Xueliang(Department of Rheumatology and Immunology,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,Hebei,China;Department of Vascular Gland Surgery,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,Hebei,China)

机构地区：[1]河北北方学院附属第一医院风湿免疫科,河北张家口075000 [2]河北北方学院附属第一医院血管腺体外科,河北张家口075000

出　　处：《血管与腔内血管外科杂志》2022年第6期703-707,712,共6页Journal of Vascular and Endovascular Surgery

基　　金：河北省2020年度医学科学研究课题计划(20200513)。

摘　　要：目的探讨环磷酰胺联合波生坦对结缔组织病-肺间质病变合并肺动脉高压(PAH)患者的临床疗效。方法选取2019年6月至2020年4月河北北方学院附属第一医院收治的160例结缔组织病-肺间质病变合并PAH患者,采用随机数字表法将患者分为单纯组和联合组,各80例。单纯组患者给予环磷酰胺治疗,联合组患者给予环磷酰胺联合波生坦治疗。比较两组患者治疗前后的临床指标:肺动脉收缩压(PASP)、Borg呼吸困难评分、高分辨率计算机断层扫描(HRCT)评分、六分钟步行试验(6MWT);心功能指标:左室射血分数(LVEF)、舒张早期充盈速度/舒张晚期充盈速度(E/A)、左心房内径(LAD)、左室舒张末期内径(LVEDD)、三尖瓣反流速率(TRR);肺功能指标:用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))、FEV_(1)/FVC、动脉血氧分压(PaO_(2))、肺一氧化碳弥散量(D_(L)CO);血清指标:内皮素-1(ET-1)、一氧化氮(NO)水平。比较两组患者治疗期间不良反应发生情况。结果治疗后,联合组患者的PASP、Borg呼吸困难评分、HRCT评分均低于单纯组患者,6MWT长于单纯组患者,差异均有统计学意义(P<0.05)。治疗后,联合组患者的LVEF、E/A均高于单纯组患者,LAD、LVEDD、TRR均低于单纯组患者,差异均有统计学意义(P<0.05)。治疗后,联合组患者的PaO_(2)、FVC、FEV_(1)、FEV_(1)/FVC、D_(L)CO均高于单纯组患者,差异均有统计学意义(P<0.05)。治疗后,联合组患者的血清ET-1水平低于单纯组患者,NO水平高于单纯组患者,差异均有统计学意义(P<0.05)。两组患者的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论环磷酰胺联合波生坦治疗能够提高对结缔组织病-肺间质病变合并PAH患者的临床疗效,进一步改善患者的心功能、肺功能及血清指标,安全可行。Objective To investigate the clinical efficacy of cyclophosphamide combined with bosentan in patients with connective tissue disease associated lung interstitial disease(CTD-ILD)complicated with pulmonary hypertension.Method A total of 160 patients with CTD-ILD complicated with pulmonary hypertension who were admitted to the First Affiliated Hospital of Hebei North University from June 2019 to April 2020 were enrolled in this study.Randomized number table method was used to divide the patients into single group and combined group,with 80 cases in each group.Patients in the simple group were treated with cyclophosphamide,and patients in the combined group were treated with cyclophosphamide and bosentan.The clinical indexes of the two groups before and after treatment were compared:pulmonary artery systolic pressure(PASP),Borg dyspnea score,high resolution computer tomography(HRCT)score,6 minute walking test(6MWT);cardiac function indexes:left ventricular ejection fraction(LVEF),early diastolic filling velocity/late diastolic filling velocity(E/A),left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD),tricuspid regurgitation rate(TRR);lung function indicators:forced vital capacity(FVC),forced expiratory volume in one second(FEV_(1)),FEV_(1)/FVC,partial pressure of oxygen in arterial blood(PaO_(2)),diffusion capacity of carbon monoxide of lung(D_(L)CO);serum indicators:endothelin-1(ET-1),nitric oxide(NO)levels.The incidence of adverse reactions between the two groups was compared.Result After treatment,PASP,Borg and HRCT scores of patients in the combined group were lower than those in the simple group,and 6MWT was longer than that in the simple group,with statistical significance(P<0.05).After treatment,LVEF and E/A in the combined group were higher than those in the simple group,while LAD,LVEDD and TRR were lower than those in the simple group,with statistical significance(P<0.05).After treatment,PaO_(2),FVC,FEV_(1),FEV_(1)/FVC and D_(L)CO in the combined group were higher than those in the singl

关 键 词：结缔组织病 肺间质病变 肺动脉高压 环磷酰胺 肺功能 心功能 

分 类 号：R543[医药卫生—心血管疾病]