波生坦在先天性心脏病术后肺动脉高压治疗中的应用及其对血清ET-1及VEGF水平的影响机制

Application of Bosentan in the treatment of pulmonary hypertension after congenital heart disease and the mechanism of its effect on serum ET-1 and VEGF levels

目的:探究对先天性心脏病术后肺动脉高压患者应用波生坦治疗后对患者血清内皮素-1(Endothelin-1,ET-1)及血管内皮生长因子(Vascular endothelial growth factor,VEGF)水平的影响及治疗价值。方法:选取我科2020年9月至2021年11月期间107例先天性心脏病术后肺动脉高压(Pulmonary hypertension,PAH)患者作为研究对象,根据随机数字分组法将其分为对照组(n=53)和观察组(n=54),对照组采用基础干预联合口服枸橼酸西地那非治疗,观察组在对照组基础上联合波生坦治疗。在治疗前及治疗4 w后,应用彩色多普勒超声检测仪检测并对比两组患者的肺血管阻力(Pulmonary vascular resistance,PVR)、平均动脉压(Mean arterial pressure,MAP)和肺动脉高压(Pulmonary hypertension,mPAP);在治疗前及治疗4 w后,应用酶联免疫吸附法检测并对比患者的ET-1和VEGF;在治疗前及治疗4 w后,应用6 min步行试验(6 min Walking test,6MWD)、呼吸困难指数评分(Dyspnea index score,Borg评分)检测并对比两组患者的活动耐力水平。结果:实施干预后,观察组患者MAP水平较对照组无明显差异(P>0.05),观察组患者PVR、mPAP水平均低于对照组(P<0.05);治疗后,两组患者VEGF水平对比无明显差异(P>0.05),观察组患者ET-1水平低于对照组(P<0.05);治疗后,观察组患者6MWD距离大于对照组,Borg评分小于对照组(P<0.05)。结论:波生坦可以改善先天性心脏病术后肺动脉高压患者的血流动力学水平和血管内皮功能,提高患者的预后活动耐力。

Objective:To explore the effects and therapeutic value of a new method of treating patients with pulmonary hypertension after operation of congenital heart disease with bosentan on serum endothelin-1(ET-1)and Vascular endothelial growth factor(VEGF).Methods:A total of 107 patients with Pulmonary hypertension(PAH)after congenital heart disease were selected from our department from September 2020 to November 2021.The patients were divided into control group(n=53)and observation group(n=54)according to the random number method.The control group was treated with sildenafil citrate orally on the basis of basic intervention.Observation group was treated with bosentan on the basis of control group.Before and 4 weeks after treatment,color doppler ultrasonography was used to detect and compare pulmonary vascular resistance(PVR),mean arterial pressure(MAP)and pulmonary hypertension(mPAP)of the two groups.Before treatment and 4 weeks after treatment,the serum endothelin-1(ET-1)and vascular endothelial growth factor(VEGF)of the patients were detected and compared using an enzyme linked immunosorbent method.Before treatment and 4 weeks after treatment,6 min walking test(6MWD)and Dyspnea index score(Borg score)were used to detect and compare the activity endurance levels of two groups.Results:After intervention,there was no significant difference in MAP level in observation group compared with the control groups(P>0.05),and PVR and mPAP levels in observation group were lower than those in control group(P<0.05).After treatment,there was no significant difference in VEGF level between two groups(P>0.05),and ET-1 level in observation group was lower than control group(P<0.05).After treatment,the 6MWD distance of the observation group was larger than that of the control group,and Borg score was smaller than that of the control group(P<0.05).Conclusion:Bosentan can improve the hemodynamic level and vascular endothelial function of patients with pulmonary hypertension after congenital heart disease,and improve the prognostic activity endurance of patients.