辛伐他汀治疗COPD合并肺动脉高压的临床研究

Clinical research on simvastatin treatment on patients with chronic obstructive pulmonary disease and pulmonary hypertension

目的探讨辛伐他汀治疗慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者肺动脉压、动脉血气、肺功能以及对血浆内皮素-1(ET-1)、脑钠肽(BNP)的影响。方法选择稳定期COPD合并PH患者36名,随机分成治疗组和对照组,两组患者均按COPD常规治疗,治疗组加用辛伐他汀40 mg/d,于治疗前及治疗三月后检测肺动脉压、动脉血气、肺功能以及血浆ET-1、BNP水平。结果治疗组和对照组临床疗效分别66.7%和50.0%。治疗组优于对照组;两组肺动脉平均压治疗后均降低(P<0.05),治疗组较对照组降低更显著(P<0.05);治疗组肺功能改善较对照组更明显(P<0.05);治疗组治疗3个月时ET-1和BNP的水平与对照组比较明显下降(P<0.05,P<0.05)。结论辛伐他汀治疗COPD合并PH,可降低BNP的水平,降低肺动脉平均压及改善肺功能;并能降低ET-1改善内皮功能。

Objective To investigate the changes on pulmonary arterial pressure,arterial blood gas, pulmonary function and the endothelin-1 （ET-1） and brain natriuretic peptide （BNP） level of chronic obstructive pulmonary disease （COPD） with pulmonary hypertension （PH） with simvastatin therapy. Methods Thirty-six patients with stable COPD complicating PH, were randomly divided into treatment group and control group. Two groups both received conventional therapy according to COPD. The former received simvastatin 40 mg/day, and the latter without simvastatin treatment. Pulmonary arterial pressure, arterial blood gas, pulmonary function were detected and blood samples were collected before and 3 months after simvastatin administration. The levels of ET-1 and BNP were measured. Results The clinical effective power in the treatment group and the control group were 66.7% and 50. 0% respectively. Therapeutic efficacy in the treatment group was higher than that in the control group. The significant degrade of pulmonary arterial pressure was observed in the treatment group （ P 〈 0. 05 ）. After 3 months of simvastatin treatment, the plasma ET-1 and BNP level were both reduced obviously （ P 〈 0. 05 ）. The pulmonary function improvement in the treatment group was more obvious than that in the control group （ P 〈 0. 05 ）. Conclusion In COPD with PH patients,3 month treatment with simvastain does reduce the plasma BNP and ET-1 level degrade the pulmonary arterial mean pressure, improve the pulmonary function, and furthermore improve endothelial function.