Efficacy of sildenafil citrate in treating pulmonary hypertension associated with connective tissue disease
-
摘要:
目的 探讨结缔组织病相关性肺动脉高压(CTD-PAH)患者口服枸橼酸西地那非治疗前后血流动力学参数及运动能力的变化，以评价其临床疗效。 方法 选择2022年1月1日—2023年3月1日安徽医科大学安庆医学中心(安庆市立医院)风湿免疫科门诊及病房诊治的26例CTD-PAH患者作为研究对象，入组患者给予枸橼酸西地那非连续口服12周；观察治疗前后6 min步行试验(6MWT)距离、肺动脉收缩压(PASP)、N末端B型利钠肽(NT-proBNP)等主要观测指标的变化；并随访患者有关实验室指标和血压及心率情况。 结果 (1) 经治疗后，患者6MWT距离从(271.231±34.386)m增加至(423.310±44.909)m；PASP由(103.080±8.309)mmHg(1 mmHg=0.133 kPa)降低至(69.058±4.995)mmHg；血浆NT-proBNP由(1 983.650±46.175)pg/mL降低至(937.458±203.686)pg/mL，3项指标治疗前后比较差异均有统计学意义(均P < 0.05)。(2)不良反应：经随访观察，患者治疗前后血压、心率、肝肾功能等差异均无统计学意义(均P＞0.05)。 结论 在CTD-PAH患者中采用枸橼酸西地那非治疗，可显著提高患者的体能，降低PASP，改善心功能，且对血压、心率及肝肾功能无显著不良影响，安全性良好。 -
关键词:
- 枸橼酸西地那非 /
- 6分钟步行试验 /
- N末端B型利钠肽 /
- 结缔组织病相关性肺动脉高压
Abstract:Objective To investigate the changes of hemodynamic parameters and exercise ability in patients with pulmonary hypertension associated with connective tissue disease (CTD-PAH) before and after oral sildenafil citrate treatment, in order to evaluate its clinical efficacy. Methods Twenty-six CTD-PAH patients who visited the Outpatient and Ward of Rheumatology and Immunology Department of Anqing Medical Center of Anhui Medical University (Anqing Municipal Hospital) from January 1, 2022 to March 1, 2023 were selected as research objects. Enrolled patients were given oral sildenafil citrate for 12 weeks. The changes of 6-min walking test (6MWT), pulmonary artery systolic blood pressure (PASP) and N-terminal B-type natriuretic peptide (NT-proBNP) before and after treatment were observed. The changes of laboratory indexes, blood pressure and heart rate were followed up. Results (1) After treatment, the 6MWT distance of patients increased from (271.231±34.386) m to (423.310±44.909) m. PASP decreased from (103.080±8.309) mmHg (1 mmHg=0.133 kPa) to (69.058±4.995) mmHg. Plasma NT-proBNP decreased from (1 983.650±46.175) pg/mL to (937.458±203.686) pg/mL. The three indexes were statistically significant before and after treatment (all P < 0.05). (2) Adverse reactions: after follow-up observation, there were no significant differences in blood pressure, heart rate, liver and kidney function before and after treatment (all P>0.05). Conclusion Sildenafil citrate treatment in patients with CTD-PAH can significantly improve the physical fitness of patients, significantly reduce SPAP, improve cardiac function and have no significant adverse effects on blood pressure, heart rate, liver and kidney function, with good safety. -
表 1 26例CTD-PAH患者治疗前后6MWT距离、PASP、NT-proBNP比较(x±s)
Table 1. Comparison of 6MWT distance, PASP and NT-proBNP in 26 patients with CTD-PAH before and after treatment (x±s)
时间 6MWT距离(m) PASP(mmHg) NT-proBNP(pg/mL) 治疗前 271.231±34.386 103.080±8.309 1 983.650±46.175 治疗后 423.310±44.909 69.058±4.995 937.458±203.686 t值 13.939 19.419 25.570 P值 ＜0.001 ＜0.001 ＜0.001 
下载: 导出CSV
表 2 26例CTD-PAH患者治疗前后心率、收缩压、舒张压、平均动脉压比较(x±s)
Table 2. Comparison of heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure in 26 patients with CTD-PAH before and after treatment (x±s)
时间 心率
(次/min)收缩压
(mmHg)舒张压
(mmHg)平均动脉压
(mmHg)治疗前 85.74±7.90 112.65±16.87 75.83±8.38 84.67±10.48 治疗后 83.43±5.98 109.70±10.30 66.27±7.15 81.89±8.54 t值 3.192 1.896 1.802 3.100 P值 0.080 0.174 0.185 0.084
下载: 导出CSV
表 3 26例CTD-PAH患者治疗前后肝肾功能比较(x±s)
Table 3. Comparison of liver and kidney function in 26 patients with CTD-PAH before and after treatment (x±s)
时间 谷丙转氨酶
(U/L)谷草转氨酶
(U/L)肌酐
(μmol/L)尿素氮
(mmol/L)治疗前 23.48±5.34 24.61±7.32 74.81±28.02 6.72±1.76 治疗后 28.27±4.64 25.14±8.41 72.18±25.12 7.35±1.49 t值 1.785 0.698 0.444 1.064 P值 0.187 0.407 0.507 0.307
下载: 导出CSV
-
[1] ZHAO J L, WANG Q, WANG Q, et al. 2020 Chinese expert-based consensus on the diagnosis and treatment of connective tissue disease associated pulmonary arterial hypertension[J]. Rheumatol Immunol Res, 2021, 2(2): 63-78. doi: 10.2478/rir-2021-0010 [2] CHEN H A, HSU T C, YANG S C, et al. Incidence and survival impact of pulmonary arterial hypertension among patients with systemic lupus erythematosus: a nationwide cohort study[J]. Arthritis Res Ther, 2019, 21(1): 82. doi: 10.1186/s13075-019-1868-0 [3] PAN J, LEI L, ZHAO C, et al. Clinical characteristics and survival of patients with three major connective tissue diseases associated with pulmonary hypertension: a study from China[J]. Exp Ther Med, 2021, 22(3): 925. doi: 10.3892/etm.2021.10357 [4] LIM Y H, LOW T T, CHAN S P, et al. Pulmonary arterial hypertension in a multi-ethnic Asian population: characteristics, survival and mortality predictors from a 14-year follow-up study[J]. Respirology, 2019, 24(2): 162-170. doi: 10.1111/resp.13392 [5] POPE J E, DENTON C P, JOHNSON S R, et al. State-of-the-art evidence in the treatment of systemic sclerosis[J]. Nat Rev Rheumatol, 2023, 19(4): 212-226. doi: 10.1038/s41584-023-00909-5 [6] DEPASCALE R, DEL FRATE G, GASPAROTTO M, et al. Diagnosis and management of lung involvement in systemic lupus erythematosus and Sjögren's syndrome: a literature review[J]. Ther Adv Musculoskelet Dis, 2021, 13: 1759720X211040696. DOI: 10.1177/1759720X211040696. [7] LEMMERS J M, FRETHEIM H, KNAAPEN H K, et al. Selexipag treatment in patients with systemic sclerosis-associated pulmonary arterial hypertension in clinical practice, a case series[J]. J Scleroderma Relat Disord, 2020, 5(3): NP7-NP11. DOI: 10.1177/2397198320916082. [8] LI M T, WANG Y H, ZHAO J L, et al. Chinese SLE Treatment and Research group (CSTAR) registry 2009—2019: major clinical characteristics of Chinese patients with systemic lupus erythematosus[J]. Rheumatol Immunol Res, 2021, 2(1): 43-47. doi: 10.2478/rir-2021-0001 [9] GIORDANO N, CORALLO C, CHIRICO C, et al. Pulmonary arterial hypertension in systemic sclerosis: diagnosis and treatment according to the European Society of Cardiology and European Respiratory Society 2015 guidelines[J]. J Scleroderma Relat Disord, 2019, 4(1): 35-42. doi: 10.1177/2397198318808998 [10] 朱玲娴, 赵荫环, 张蕊, 等. 系统性硬化症发生肺动脉高压的独立危险因素分析[J]. 风湿病与关节炎, 2023, 12(1): 14-18.ZHU L X, ZHAO Y H, ZHANG R, et al. Independent risk factors of pulmonary hypertention in systemic sclerosis[J]. Rheumatism And Arthritis, 2023, 12(1): 14-18. [11] 谢长好, 李志军. 系统性红斑狼疮的诊断与治疗[J]. 中华全科医学, 2020, 18(4): 527-528. http://www.zhqkyx.net/article/id/240c4592-9f47-4c70-a324-2bf8221505c8XIE C H, LI Z J. Diagnosis and treatment of systemic lupus erythematosus[J]. Chinese Journal of General Practice, 2020, 18(4): 527-528. http://www.zhqkyx.net/article/id/240c4592-9f47-4c70-a324-2bf8221505c8 [12] QIAN J Y, DING Y F, YANG X Y, et al. The diagnostic and prognostic value of growth differentiation factor-15 in systemic lupus erythematosus-associated pulmonary arterial hypertension[J]. Pulm Circ, 2023, 13: e12195. DOI: 10.1002/pul2.12195. [13] WEATHERALD J, HUMBERT M. PDE5 to keep them alive: the use of phosphodiesterase type-5 inhibitors in severe pulmonary hypertension associated with interstitial lung disease[J]. Respirology, 2023, 28(3): 212-214. doi: 10.1111/resp.14399 [14] 王建军, 吕群, 龚玲, 等. 原发性干燥综合征合并间质性肺病患者临床与影像特点分析[J]. 中华全科医学, 2019, 17(8): 1275-1278. doi: 10.16766/j.cnki.issn.1674-4152.000920WANG J J, LYU Q, GONG L, et al. Analysis of clinical and imaging features of primary Sjogren ' s syndrome complicated with interstitial lung disease[J]. Chinese Journal of General Practice, 2019, 17(8): 1275-1278. doi: 10.16766/j.cnki.issn.1674-4152.000920 [15] SANGANI R A, LUI J K, GILLMEYER K R, et al. Clinical characteristics and outcomes in pulmonary manifestations of systemic sclerosis: contribution from pulmonary hypertension and interstitial lung disease severity[J]. Pulm Circ, 2022, 12(4): e12117. DOI: 10.1002/pul2.12117. [16] VILELA V S, DIAS M M, SALGADO Â A, et al. Pulmonary hypertension in systemic sclerosis: diagnosis by systematic screening and prognosis after three years follow-up[J]. BMC Pulm Med, 2021, 21(1): 251. doi: 10.1186/s12890-021-01618-z [17] 朱轩池, 刘秀梅. 系统性硬化症相关肺动脉高压的治疗进展[J]. 临床与病理杂志, 2021, 41(7): 1696-1702.ZHU X C, LIU X M. Progress in the treatment of systemic sclerosis-associated pulmonary arterial hypertention[J]. J Clin Pathol Res, 2021, 41(7): 1696-1702. [18] VONK M C, VANDECASTEELE E, VAN DIJK A P. Pulmonary hypertension in connective tissue diseases, new evidence and challenges[J]. Eur J Clin Invest, 2020, 51(4): e13453. DOI: 10.1111/eci.13453. [19] TRAN-DUY A, MORRISROE K, CLARKE P, et al. Cost-effectiveness of combination therapy for patients with systemic sclerosis-related pulmonary arterial hypertention[J]. J Am Heart Assoc, 2021, 10(7): e015816. DOI: 10.1161/JAHA.119.015816. [20] AHMED W S, GEETHAKUMARI A M, BISWAS K H. Phosphodiesterase 5(PDE5): structure-function regulation and therapeutic application of inhibitors[J]. Biomed Pharmacother, 2021, 134: 111128. DOI: 10.1016/j.biopha.2020.111128. [21] RUARO B, CONFALONIERI M, SALTON F, et al. The relationship between pulmonary damage and peripheral vascular manifestations in systemic sclerosis patients[J]. Pharmaceuticals(Basel), 2021, 14(5): 403. doi: 10.3390/ph14050403 [22] 刘玉芳, 石磊. 波生坦治疗结缔组织病相关肺动脉高压临床疗效观察及安全性分析[J]. 中国药物与临床, 2019, 19(6): 867-869.LIU Y F, SHI L. Clinical efficacy and safety of bosentan in treatment of connective tissue disease associated pulmonary arterial hypertention[J]. Chinese Remedies &Clinics, 2019, 19(6): 867-869. [23] WANG Q, QIAN J Y, LI M T, et al. Risk assessment in systemic lupus erythematosus-associated pulmonary arterial hypertension: CSTAR-PAH cohort study[J]. Ther Adv Chronic dis, 2022, 13: 20406223221112528. DOI: 10.1177/20406223221112528. -
点击查看大图
表(3)
计量
- 文章访问数: 93
- HTML全文浏览量: 33
- PDF下载量: 9
- 被引次数: 0
