心肺运动试验对评估肺动脉高压患者西地那非药物效果的作用

Evaluation of Cardiopulmonary Exercise Testing on Sildenafil Effect for Treating the Patients With Pulmonary Arterial Hypertension

目的：探讨心肺运动试验对评估肺动脉高压患者西地那非药物效果的作用。方法：入选2012-01至2014-01阜外医院新诊断的仅接受西地那非治疗的动脉性肺动脉高压患者25例,于基线,治疗后6～12个月、13～18个月评估患者心肺运动试验、心脏超声、心功能、6 min步行距离和N末端B型脑钠肽原（NT-pro BNP）的变化。结果：与正常对照组相比,动脉性肺动脉高压患者用氧能力（峰值氧耗量,峰值氧脉搏）以及通气效率（呼气末二氧化碳分压,分钟通气量与二氧化碳排出量比值）明显下降（P均〈0.05）。西地那非治疗（8±2）个月后,用氧能力以及通气效率明显改善,同时心功能、6 min步行距离和NT-pro BNP也出现改善（P均〈0.05）。继续西地那非治疗（16±2）个月时,6 min步行距离变化不明显（P=0.26）,但峰值氧耗量、峰值氧脉搏较（8±2）个月时下降（P=0.04,0.06）,通气效率减低（表现为呼气末二氧化碳分压下降、分钟通气量与二氧化碳排出量比值升高,P=0.04和0.04）以及NT-pro BNP开始出现增加（P=0.05）。结论 ：心肺运动试验能有效评估肺动脉高压患者西地那非治疗疗效并指导用药。

Objective： To evaluate cardiopulmonary exercise testing （CPET） on sildenaifl effect for treating the patients with pulmonary arterial hypertension （PAH）. Methods： A total of 25 PAH patients received sildenaifl treatment in our hospital from 2012-01 to 2014-01 were enrolled as PAH group, in addition, there were a Control group including 24 healthy subjects. The CPET, echocardiography, NYHA function class, 6-mimute walking distance （6MWD） and plasma levels of NT-proBNP at the baseline, （6-12） months and （13-18） months after sildenaifl treatment were assessed and compared between 2 groups. Results： Compared with Control group, PAH group showed decreased aerobic capacity （peakVO？2, Peak O2pulse） and ventilation efifciency （PETCO2@AT, VE/VCO2@AT）, allP〈0.05. At （8±2） months after sildenaifl treatment, aerobic capacity and ventilation efifciency was improved, meanwhile, NYHA function class, 6MWD and plasma levels of NT-proBNP were improved, allP〈0.05. At （16±2） months after sildenaifl treatment, 6MWD was similar,P=0.26, while peak VO？2 and peak O2 pulse were decreased than they were at （8±2） months after sildenaifl treatment,P=0.04 and 0.06; the ventilation efifciency was elevated （as presented by increased VE/VCO2@AT and decreased PETCO2@AT,P=0.04 and P=0.04）; plasma level of NT-proBNP was increased,P=0.05. Conclusion： CPET can effectively evaluate sildenaifl effect for treating PAH patients and therefore and guide the drugs therapy.