安立生坦治疗肺动脉高压42例临床观察

Clinical Observation of Ambrisentan in Treatment of 42 Patients with Pulmonary Artery Hypertension

目的观察安立生坦治疗肺动脉高压(pulmonary arterial hypertension,PAH)临床疗效。方法 2011年4月—2013年10月在武汉亚洲心脏病医院住院的PAH 89例,将应用安立生坦治疗的42例作为治疗组,将仅采用基础治疗的47例作为对照组,于治疗前及治疗12周后测量两组6 min步行距离、超声心动图测量指标、WHO肺动脉高压心功能分级(WHO FC)以及血浆B型钠尿肽(BNP)以及血常规和生化指标的变化情况。结果治疗12周后治疗组6 min步行距离较治疗前和对照组增加,BNP和血清总胆红素水平较治疗前和对照组下降(P<0.01);超声心动图测量右心室舒张末内径(RVEDD)较治疗前和对照组缩小,左心室舒张末内径(LVEDD)较治疗前和对照组扩大(P<0.01)。WHO FC心功能分级较治疗前和对照组明显好转(P<0.01)。对照组治疗前后6 min步行距离、BNP和血清总胆红素水平、RVEDD、LVEDD、WHO FC心功能分级比较差异无统计学意义(P>0.05)。治疗组无死亡病例,不良反应轻微,其中下肢水肿者给予利尿剂好转,其他均自行缓解。对照组死亡2例,均为猝死。结论安立生坦可显著改善PAH患者心功能及运动耐力,安全性和耐受性良好。

Objective To observe clinical efficacy of Ambrisentan in treatment of pulmonary arterial hypertension（ PAH）. Methods A total of 89 patients with PAH were divided into Ambrisentan group（ 42 inpatients treated with Ambrisentan） and control group（ 47 patients treated with basal therapy） during April 2011 and October 2013 in Wuhan Asia Heart Hospital,and indexes of the 6-min walking distance（ 6-MWD）,ultrasonic cardiography（ UCG）,WHO PAH functional classification（ WHO FC）,brain natriuretic peptide（ BNP）,routine blood test and biochemistry were detected before and after Ambrisentan treatment for 12 weeks,and then its safety was evaluated. Results In Ambrisentan group,the value of 6-MWD after treatment for 12 weeks was increased,but the levels of BNP and serum total bilirubin were decreased compared with those before treatment and in control group（ P〈 0. 01）; value of right ventricular end-diastolic internal diameter（ RVEDD） measured by echocardiogram was decreased,while left ventricular end-diastolic diameter（ LVEDD） was expanded compared with those before treatment and in control group（ P〈 0.01）. WHO FC was significant improved compared with those before treatment and in control group（ P 〈 0. 01）. The differences in indexes of6-MWD,BNP and serum total bilirubin levels,RVEDD,LVEDD and WHO FC were not statistically significant（ P〉 0. 05）. No patients died in treatment group,and adverse reactions were mild,in which edema of lower extremity were improved by diuretics treatment,and others were spontaneous remission. Two patients in control group died of a sudden death. Conclusion Ambrisentan treatment can significantly improve heart function and exercise tolerance of the PAH patients with better safety and tolerance.