脱氢穿心莲内酯辅助治疗对重度COPD急性加重期患者肺动脉高压血流动力学的影响

The Effect of Dehydroandrographolide Succinate on Hemodynamics in Patients with COPD Associated Pulmonary Arterial Hypertension

目的探讨脱氢穿心莲内酯辅助治疗对重度AECOPD患者肺动脉高压血流动力学的影响。方法 60例重度AECOPD患者(D级)随机平均分为脱氢穿心莲内酯(穿琥宁)+常规治疗组(干预组)和常规治疗组(对照组)。取30例健康体检患者作为空白组。分别测定0天和14天时患者动脉血气指标(PH、PO2和PCO2)、FEV1占预计值%和血浆ET-1和TXB2水平,并使用彩色多普勒超声心动图(CDE)测定射血分数(EF%)、平均肺动脉压(mPAP)、吸气相上腔静脉最大前向血流速度(VINS)、呼气相肺活量最大前向血流速度(VEXP)和VINS/VEXP比值。结果经14天治疗后患者动脉血气指标(PH、PO2和PCO2)、FEV1占预计值%、血浆ET-1和TXB2水平、EF%、mPAP、VINS、VEXP和VINS/VEXP比值均明显改善(均P>0.05),同时与对照组相比较干预组动脉血气指标(PH、PO2和PCO2)和FEV1占预计值%未见明显差异(均P>0.05),但血浆ET-1和TXB2水平、EF%、mPAP、VINS、VEXP和VINS/VEXP比值干预组改善更明显(均P<0.05)。同时该实验过程中干预组患者未出现与脱氢穿心莲内酯相关的严重不良反应。结论脱氢穿心莲内酯可通过调节血管内皮细胞功能降低肺循环压力改善AECOPD相关的肺动脉高压。该研究为脱氢穿心莲内酯应用于AECOPD相关的肺源性肺动脉高压和慢性肺源性心脏病的临床治疗奠定了基础。

Objective To evaluate the effect of dehydroandrographolide succinate （DAS） on hemodynamies in patients with COPD associated pulmonary arterial hypertension （PAH）. Methods Sixty patients with AECOPD （D grade） were randomly divided into 2 groups, regular treatment group （control group） and DAS ＋ regular treatment group （intervention group）, with 30 in each. Meanwhile, 30 normal health examination patients were included as blank group. Arterial blood gas （ABG） indexes, FEV1 ;, the serum levels of ET-1 and TX/3z were measured. Otherwise, EFt, mPAP, VINS, VEXP and VINS/VEXP ratio were detected by color Doppler echocardiography （CDE）, before and after 14 days treatment. Results After 14 days treatment, ABG indexes （PH, PO2 and PCO2）, FEV1%, the serum levels of ET-1 and TX;, EFt, mPAP, VINS, VEXP and VINS/VEXP ratio were all improved in both 2 groups （P〈0. 05 in all）. However, no difference on ABG indexes （PH, PO2 and PCO2） and FEV1% was found between two groups （P〉 0.05 in all）. Nevertheless, the serum levels of ET-1 and TXBz and EFt, mPAP, VINS, VEXP and VINS/VEXP ratio in intervention group were significantly improved, compared with control group （P〈0. 05 in all）. Meanwhile, no severe side effect has been found in this study. Conclusion Our results showed that DAS may be an effective drug in COPD associated PAH treatment by improving endothelial cells function and reducing pulmonary circulation resistance. However, more multiple center and wild scale studies should be applied to identify the value of DAS in the treatment of COPD associated PAH.