重组人脑钠肽治疗重度肺动脉高压患者一例报告并文献复习

Reversibility of Medically Unresponsive Idiopathic Pulmonary Artery Hypertension with Nesiritide:One Case Report and Literature Review

目的探讨重组人脑钠肽(rh-BNP)对肺动脉高压的治疗作用。方法总结1例常规降肺动脉压治疗失败、使用rh-BNP治疗的重度特发性肺动脉高压患者的临床特点,并复习相关文献。结果该例患者使用rh-BNP治疗后临床症状显著改善。文献提示rh-BNP可升高NOx(nitrogen oxides)和环磷酸鸟苷等血管活性因子水平,阻断机体对于缺氧产生的肺循环血管收缩,降低肺动脉压,对抗心肌重构和纤维化,对肺动脉高压有一定治疗效果。结论 rh-BNP可以改善危重的肺动脉高压患者临床症状,rh-BNP与5型磷酸二酯酶抑制剂联合用药可能是一种新的治疗策略。

Objective To explore whether nesiritide（ recombinant human brain natriuretic peptide,rh-BNP） could be used to treat pulmonary artery hypertension. Methods A 34-year-old female patient with severe symptomatic idiopathic pulmonary artery hypertension was reported,who was refractory to routine therapies,including prostacyclin. Therapy with continuous nesiritide infusion resulted in significant decrease in pulmonary vascular resistance and an improvement in dyspnea. The relevant literature was reviewed.Results The clinical symptoms of this patient relieved significantly after nesiritide therapy. Literature review showed that nesiritide could increase the production of nitrogen oxides and cyclic guanosine monophosphate in the body,so as to dilate the vessels which were shrunk due to hypoxia and low down the pulmonary vascular resistance. Conclusion Nesiritide is useful to treat severe pulmonary artery hypertension,and combination with phosphodiesterase type-5 inhibitors may be a brand new therapy of value.