Efficacy of sildenafil citrate in treating pulmonary hypertension associated with connective tissue disease
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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 
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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
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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
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