慢性栓塞性肺动脉高压的药物治疗进展

Advance in Medical Therapies for Chronic Thromboembolic Pulmonary Hypertension

药物治疗对不能手术和在围手术期的慢性栓塞性肺动脉高压患者的治疗起重要的作用。传统的药物如抗凝药物、利尿剂、洋地黄类、氧疗等不能改变疾病的预后,治疗效果也有限。近年来,一些新型药物被用于治疗肺动脉高压,包括前列腺环素类似物、内皮素受体拮抗剂和磷酸二酯酶5的抑制剂等。它们在非栓塞性肺动脉高压的治疗中可以明显改善预后,由于相似的病理机制,所以它们对栓塞性肺动脉高压也可能有效,但证据有限。本文将对这些药物在慢性栓塞性肺动脉高压治疗中的应用作一总结。

Pharmacotherapy may be particularly useful in treating patients with chronic thromboembolic pulmonary hypertension （CTEPH）, who are poor candidates for surgery, or as bridging therapy in those where there is significant preoperative risk. Conventional medical treatments, such as anticoagulation, diuretics, digitalis, and chronic oxygen therapy, showed low efficacy in the treatment of CTEPH as they did not affect underlying disease processes, Over the last decade, several novel therapies have been developed for pulmonary arterial hypertension （PAH）, including prostacyclin analogs, endothelin receptor antagonists, and phosphodiesterase-5 inhibitors. Evidence of efficacy in PAH, coupled with studies showed histopathologic similarities with CTEPH, which provided a rationale to extend the use of some of these medications to the treatment of CTEPH. However, direct evidence from clinical trials in CTEPH was limited to date. This article reviews the possible use of novel PAH medications in CTEPH.