2019 年第 12 期 第 14 卷

波生坦治疗老年慢性阻塞性肺疾病稳定期合并肺动脉高压的临床效果及对患者右心功能的影响

Clinical efficacy of bosentan in treatment of elderly patients with stable chronic obstructive pulmonary disease and pulmonary hypertension and the effect on right heart function

作者：尹义平张敏

英文作者：

单位：442000湖北省十堰市人民医院(湖北医药学院附属人民医院)呼吸内科（尹义平）；434020湖北省荆州市，湖北中医药高等专科学校医疗系内科教研室（张敏）

英文单位：

关键词：慢性阻塞性肺疾病；肺动脉高压；波生坦；右心功能；缺氧

英文关键词：

• 摘要：

• 【摘要】目的    探究波生坦治疗老年慢性阻塞性肺疾病(COPD)稳定期合并肺动脉高压(PH)的临床效果及对患者右心功能的影响。方法    回顾性分析2017年3月至2018年10月湖北省十堰市人民医院诊治的86例COPD稳定期合并PH老年患者临床资料。根据其治疗方法分为常规组（42例）及波生坦组（44例）。2组均给予氧疗、抗感染、维持水电解质平衡等对症治疗措施，常规组在此基础上予以沙美特罗替卡松吸入治疗，波生坦组在常规组基础上予以波生坦口服治疗。比较2组治疗前及治疗12周后血清学指标［内皮素1、肾上腺髓质素(ADM)、缺氧诱导因子1α(HIF-1α)］、缺氧状态［动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)］、肺功能［6 min步行距离(6MWD)、改良医学研究学会呼吸困难量表(MMRC)］、PH情况［肺动脉收缩压(PASP)、肺动脉舒张压(PADP)、肺动脉平均压(PAMP)］、右心功能［右心室侧壁三尖瓣环收缩期位移(TAPSE)、右心室侧壁三尖瓣环收缩期峰值运动速度(PSv)、右心室心肌工作指数(Tei指数)］差异，并记录治疗期间药物不良反应发生情况。结果    治疗12周后，2组血清学指标（内皮素1、ADM、HIF-1α）、部分缺氧状态指标（PaCO2）、部分肺功能指标（MMRC评分）、PH情况（PASP、PADP、PAMP）、部分右心功能指标（Tei指数）均较治疗前降低，且波生坦组低于常规组，差异均有统计学意义（均P＜0.05）；PaO2、6MWD、TAPSE、PSv则较治疗前升高，且波生坦组高于常规组［（81±5）mmHg（1 mmHg=0.133 kPa）比（77±5）mmHg、（385±32）m比（341±31）m、（18.9±2.1）mm比（17.2±2.1）mm、（14.5±1.5）cm/s比（13.5±1.6）cm/s］，差异均有统计学意义（均P＜0.05）。2组治疗期间均未出现转氨酶升高等肝功能损伤情况，且2组药物不良反应发生率差异无统计学意义（P＞0.05）。结论    波生坦治疗COPD稳定期合并PH老年患者效果显著，不仅能促进PH减轻、纠正机体缺氧状态，还能改善心肺功能，且安全性较高。

• 【Abstract】Objective    To investigate the clinical efficacy of bosentan in treatment of elderly patients with stable chronic obstructive pulmonary disease(COPD) and pulmonary hypertension(PH) and the effect on right heart function. Methods    Clinical data of 86 elderly patients with stable COPD and PH admitted to Shiyan People′s Hospital, Hubei Province from March 2017 to October 2018 were retrospectively analyzed. All patients were treated with symptomatic treatments including oxygen inhalation, anti-infection and water-electrolyte balance control; 42 patients had salmeterol/fluticasone inhalation(routine group) and 44 patients took bosentan additionally(bosentan group). Serological indicators［endothelin-1(ET-1), adrenomedullin(ADM), hypoxia-inducible factor-1α(HIF-1α)］, hypoxic indicators［arterial partial pressure of oxygen(PaO2), arterial partial pressure of carbon dioxide(PaCO2)］, lung function indicators［6 min walking distance(6MWD), Modified Medical Research Council(MMRC) Dyspnea Scale］, PH indicators［pulmonary arterial systolic pressure(PASP), pulmonary arterial diastolic blood pressure(PADP), pulmonary arterial mean pressure(PAMP)］, right cardiac function indicators［right ventricular sidewall tricuspid annular plane systolic excursion(TAPSE), right ventricular sidewall tricuspid annular plane systolic peak velocity(PSv), right ventricular myocardial work index(Tei index)］ and adverse reactions were analyzed after 12 weeks of treatment. Results    After 12 weeks of treatment, ET-1, ADM, HIF-1α, PaCO2, MMRC score, PASP, PADP, PAMP and Tei index significantly decreased in both groups, and the indexes in the bosentan group were lower than those in the routine group(all P<0.05); PaO2, 6MWD, TAPSE and PSv significantly increased and these indexes in the bosentan group were higher than those in the routine group［（81±5）mmHg vs （77±5）mmHg, （385±32）m vs （341±31）m, （18.9±2.1）mm vs （17.2±2.1）mm, （14.5±1.5）cm/s vs （13.5±1.6）cm/s］(all P<0.05). No liver function damage such as elevated transaminases was observed during treatment, and there was no significant difference in the incidence of adverse drug reactions between groups(P>0.05). Conclusions    Bosentan is safe and effective in treating elderly patients with stable COPD and PH. It can help alleviate PH, correct hypoxia and improve cardiopulmonary function.