波生坦治疗儿童肺动脉高压疗效的影响因素分析

Influencing Factors of Efficacy of Bosentan in the Treatment of Children with Pulmonary Arterial Hypertension

目的:探讨波生坦治疗儿童肺动脉高压疗效的影响因素。方法:选取2013年6月至2016年6月在我院诊断为肺动脉高压且接受波生坦治疗的患儿68例,定期随访,以患儿死亡或行肺移植治疗为随访终点,收集患儿的临床资料,包括年龄、性别、体质量指数(BMI)、病史、体格检查及治疗后血常规、心导管检查结果,对相关指标进行单因素及多因素分析,评价各种因素与波生坦治疗小儿肺动脉高压疗效的相关性。结果:患儿的年龄、水肿及纽约心脏病协会(NYHA)心功能分级、肌钙蛋白I(TnI)、血红蛋白(HGB)、总胆红素(TBil)、肺小动脉阻力指数(PVRI)等因素与波生坦治疗儿童肺动脉高压的临床效果相关(P<0.05)。进一步多因素Logistic回归分析显示,年龄<5岁、NYHA心功能分级为Ⅲ~Ⅳ级、TBil≥6.23μmol/L是波生坦治疗肺动脉高压疗效不佳(发生终点事件)的独立危险因素(P<0.05)。结论:影响波生坦治疗儿童肺动脉高压疗效的因素较多,临床应针对性干预。

Objective:To explore the influencing factors of efficacy of bosentan in the treatment of children with pulmonary arterial hypertension.Methods:Totally 68 children with pulmonary arterial hypertension admitted into our hospital from Jun.2013 to Jun.2016 were extracted for regular follow-up.The follow-up endpoint was the death of the child or the treatment of lung transplantation.Clinical data were collected,including age,gender,body mass index(BMI),course of disease,physical examination,blood routine and cardiac catheterization results after treatment.Univariate analysis and multivariate analysis were performed to evaluate the correlation between various factors and the therapeutic effects of bosentan on pulmonary arterial hypertension in children.Results:Age,edema,New York Heart Association(NYHA)grade of cardiac function,troponin I(TnI),hemoglobin(HGB),total bilirubin(TBil),pulmonary vascular resistance index(PVRI)and other factors were correlated with the clinical effects of bosentan on pulmonary arterial hypertension in children(P<0.05).Further multivariate logistic regression analysis showed that age<5 years,NYHA grade of cardiac function fromⅢtoⅣ,and TBil≥6.23μmol/L are independent risk factors for the poor efficacy(endpoint events)of bosentan on pulmonary arterial hypertension in children(P<0.05).Conclusion:There are many factors affecting the efficacy of bosentan in the treatment of pulmonary arterial hypertension in children,and targeted interventions should be taken in clinic.