小剂量氯沙坦和低分子肝素对慢性阻塞性肺疾病急性加重期肺动脉高压的疗效观察

Efficacy of the combination of low dose of losartan and low-molecular heparin for pulmonary artery hypertension associated with acutely worsening chronic obstructive pulmonary disease

目的:探讨小剂量氯沙坦联合低分子肝素对慢性阻塞性肺疾病(COPD)急性加重期肺动脉高压的疗效。方法:COPD急性加重期患者共50例,分为试验组24例和对照组26例,对照组采用常规综合治疗,试验组除常规综合治疗外,加用氯沙坦(12．5 mg,po,qd)和低分子肝素(0．4 mL,腹部皮下注射,bid),疗程10d。结果:试验组肺动脉收缩压在用药后显著低于用药前[(51．21±11．85)vs．(57．92±12．56)mmHg,P＜0．05],也显著低于对照组(P＜0．05);试验组肺功能指标(FEV_1,FEV_1/FVC)较用药前显著增加,但与对照组比较无明显差异;试验组血浆D-二聚体含量显著低于用药前,也显著低于对照组(P＜0．05)。两组均无明显不良反应。结论:小剂量氯沙坦和低分子肝素合用治疗COPD急性加重期肺动脉高压疗效好,对患者预后可能产生积极影响。

Objective： To assess the efficacy of the combination of low dose of losartan and the low-molecular heparin for pulmonary artery hypertension associated with acutely worsening chronic obstructive pulmonary disease （COPD）. Methods ： 50 patients with acutely worsening COPD were randomly assigned to one of two treatment groups; the control group （n = 26） received conventional comprehensive therapy and the treatment group was administered with conventional therapy plus losartan （12.5 mg, oral, qd） and low-molecular heparin （0.4 mL, abdominal hypodermic injection, bid） for 10 days. Results： The pulmonary artery systolic blood pressure in the treatment group showed significant reduction post therapy compared with the one pre-therapy [（51.21±11.85 ） vs. （57.92±12.56） mmHg,P 〈0.05] and with the one in the control group （P 〈0.05）; the pulmonary functions （FEV1 ,FEV1/FVC） were significantly improved post-therapy compared with the one pre-therapy. No significant difference of pulmonary functions was found between the treatment and control group. The plasma D-dimer levels post therapy were significantly lower than pre-therapy and the control group （P〈0.05 ）. No significant incidence of adverse events was reported. Conclusion： Added-on low dose of losartan and low-molecular heparin offered a better prognosis in the treatment of pulmonary artery hypertension associated acutely worsening COPD.