介入封堵术及西地那非对成人室间隔缺损合并中重度肺动脉高压患者血浆脑钠肽水平的影响

Effects of transcatheter closure and Sildenafil on plasma brain natriuretic peptide in patients with ventricular septal defects combined with moderate-severe pulmonary artery hypertension

目的探讨成人室间隔缺损(VSD)伴中、重度肺动脉高压(PAH)患者经导管封堵治疗后肺动脉平均压(mPAP)及血浆脑钠肽(BNP)浓度变化以及西地那非的干预作用。方法选择20008年1月～2012年8月在我科住院并行介入封堵治疗的VSD伴中、重度PAH患者共60例,随机分为西地那非组、贝那普利组及无药物干预组各20例,术后在常规强心、利尿、抗凝治疗基础上,分别予以西地那非、贝那普利或无其他药物口服。分析介入封堵术后24 h及3个月时血浆BNP浓度及mPAP的变化。结果三组术后24 h mPAP均较术前降低,BNP较术前升高,具有统计学意义(P均<0.05)。与无药物干预组相比,术后3个月西地那非组及贝那普利组mPAP及BNP均降低,且西地那非组疗效优于贝那普利组(P均<0.05)。结论经导管封堵治疗成人VSD合并中、重度PAH可有效降低肺动脉压力及血浆BNP,西地那非治疗封堵术后PAH疗效优于贝那普利,且短期内安全、有效。

To investigate the changes of plasma brain natriuretic peptide （BNP） concentration and mean pulmonary artery pressure（mPAP） in patients with ventricular septal defects（VSD） combined with moderate-severe pulmonary artery hypertension （PAH） after transcatheter closure and the influence of Sildenafil on them. Methods A total of 60 patients（ ≥ 18 years） with VSD combined with moderate-severe PAH hospitalized in our hospital between Jan 2008 and Aug 2012 were included in the study. They were divided into 3 groups randomly, 20 in each group ： group 1 （treated with Silde- nafil, 20mg tid, ）, group 2（treated with Benazepril, 7.5-20mg qd, ） and group 3 （no drug treatment）. The plasma BNP concentration and mPAP were measured respectively before treatment, 24 hours and 3months after transcatheter closure. Results Compared to the transcatheter closure before, the mPAP decreased and the plasma BNP concentration increased significantly in 24 hours after the procedure in all groups （ all P 〈 0.05）. Compared with group 3, significant decrease in plasma BNP concentration and mPAP was observed in group 1 and group 2 after 3-month drug treatment （ all P 〈 0. 05 ） and the decrease in group 1 was greater than that in group 2. Conclusions The plasma BNP concentration and mPAP were deereased after transcatheter closure in adult VSD combined with moderate-severe PAH. The effect of Sildenafil is better than Benazepril in treating PAH after transcatheter closure.