波生坦联合辛伐他汀治疗中重度肺动脉高压的临床研究

Effects of bosentan combined with simvastatin on medium and severe pulmonary arterial hypertension

目的观察波生坦联合辛伐他汀治疗中重度肺动脉高压(PAH)的疗效。方法将61例中重度PAH患者分为波生坦联合辛伐他汀组、波生坦组和辛伐他汀组,连续治疗12周,记录治疗前后WHO心功能分级、右室收缩压(RVSP)、右室内径(RVd)、Borg呼吸困难指数(BDI)、6分钟步行距离(6MWD)、明尼苏达心衰生活质量评分(MLHFQ)及血浆N端脑钠肽原(NT-pro-BNP)水平。结果与治疗前相比,联合治疗组RVSP(62.16±3.42 vs.87.28±5.30)、RVd(2.50±0.33 vs.2.83±0.64)、BDI(3.1±1.5 vs.4.1±1.2)、NT-pro-BNP(289.1±50.7 vs.399.7±48.2)水平明显下降,6MWD(340.72±9.06 vs.291.22±4.14)明显延长(P<0.01),MLHFQ评分(42.21±4.25 vs.55.14±3.48)降低(P<0.05);与波生坦组相比,联合治疗组RVSP(23.15±6.25 vs.18.71±4.23)、RVd(0.32±0.26 vs.0.39±0.28)、MLHFQ评分(15.11±4.23 vs.11.72±5.12)与NT-pro-BNP水平(104.35±32.40 vs.82.15±61.02)降低(P<0.05),延长6MWD(52.33±3.15 vs.37.82±7.41)的疗效更显著(P<0.01)。结论波生坦联合辛伐他汀较单药能更有效治疗中重度PAH患者。

Objective To observe the effect of the combination treatment of bosentan and simvastatin in medium-severe pulmonary arterial hypertension(PAH).Methods 61 patients with PAH were allocated into three groups:a combination of bosentan and simvastatin group,bosentan group and simvastatin group.WHO heart functional classification,right ventricular systolic pressure(RVSP),right ventricle diameter(RVd),Borg dyspnea index(BDI),6 minute walk distance(6MWD),Minnesota Living with Heart Failure Questionnaire(MLHFQ) scoring and plasma NT-Pro-BNP concentration were recorded at baseline and after 12 weeks under treatment.Results Compared to baseline,RVSP(62.16±3.42 vs.87.28±5.30),RVd(2.50±0.33 vs.2.83±0.64),BDI(3.1±1.5 vs.4.1±1.2),NT-Pro-BNP level(289.1±50.7 vs.399.7±48.2) and MLHFQ scoring(42.21±4.25 vs.55.14±3.48)(P<0.05) were decreased significantly(P<0.01),6MWD(340.72±9.06 vs.291.22±4.14) was increased significantly in combination group(P<0.01);combination group had the greater effect in decreasing RVSP(23.15±6.25 vs.18.71±4.23),RVd(0.32±0.26 vs.0.39±0.28),MLHFQ scoring(15.11±4.23 vs.11.72±5.12),NT-Pro-BNP level(104.35±32.40 vs.82.15±61.02) and increasing 6MWD(52.33±3.15 vs.37.82±7.41)(P<0.01)compared with bosentan group(P<0.05).Conclusion Bosentan combined with simvastatin was more effective for patients with medium-severe PAH than single medicine treatment.