我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

西地那非治疗先天性心脏病相关性肺动脉高压的有效性与安全性

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2012年第5期
页码:
600-603
栏目:
临床研究
出版日期:
2012-10-25

文章信息/Info

Title:
Efficacy and safety of sildenafil in treatment of patients with severe pulmonary arterial hypertension secondary to congenital heart disease
作者:
张端珍; 朱鲜阳; 贾丽娟; 崔春生; 盛晓棠; 王琦光; 张 坡
(沈阳军区总医院先心病内科，辽宁 沈阳 110016)
Author(s):
ZHANG Duan-zhen;  ZHU Xian-yang;  JIA Li-juan;  CUI Chun-sheng;  SHENG Xiao-tang;  WANG Qi-guang;  ZHANG Po
(Department of Congenital Heart Disease, General Hospital, Shenyang Military Area Command, Shenyang 110016, Liaoning, China)
关键词:
肺动脉高压; 心脏病; 先天性; 西地那非; 磷酸二酯酶抑制剂; 有效性; 安全性
Keywords:
pulmonary arterial hypertension;  congenital heart disease;  sildenafil;  phosphodiesterase inhibitor;  efficacy;  safety
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的:探讨磷酸二酯酶抑制剂西地那非治疗先天性心脏病（congenital heart disease,CHD）所致重度肺动脉高压（pulmonary arterial hypertension，PAH）的有效性及安全性。方法： 对体-肺分流型CHD所致重度PAH患者33例给予西地那非治疗6个月。以6分钟步行距离试验、心电图、心脏X线、彩色多普勒超声心动图、右心导管、血细胞和血生化检查检测评估治疗效果和不良反应。结果： 西地那非治疗6个月后，所有患者6分钟步行距离显著改善(P<0.01)，18例（54%）患者自觉症状明显改善，左心室射血分数明显增加（P<0.05)。右心导管检查示肺/体循环血流量比值明显提高(P<0.01)，肺血管阻力（P<0.05)，肺/体循环压力比值（P<0.01)和血管阻力比值（P<0.01)明显下降，但有8例（24%）患者肺/体循环血流量比值下降同时肺/体循环血管阻力比值增大。不良反应事件包括脸红（n=3）、头痛（n=2）、鼻充血（n=1），异常阴茎勃起（n=1）等。实验室检查显示红细胞和血红蛋白较治疗前显著降低(P<0.01)，而肌酐轻度升高(P<0.05)。结论： CHD并发PAH患者接受西地那非治疗6个月耐受性良好，大部分患者运动耐量和血流动力学明显改善。
Abstract:
AIM:To evaluate the efficacy and safety of sildenafil in treatment of patients with severe pulmonary arterial hypertension (PAH) secondary to congenital heart disease (CHD). METHODS: Patients with severe PAH secondary to systemic-to-pulmonary shunt CHD were treated with sildenafil for 6 months. The dose of sildenafil was 25 mg three times daily in patients weighing ≥50 kg and 0.5 mg/kg thrice daily in children weighing <50 kg. Six-minute walk distance test, echocardiography, cardiac catheterization, complete blood count, and hepatic as well as renal functions were assessed at baseline and after the 6-month therapy. RESULTS: After the 6-month sildenafil treatment, all the patients had a significant increase in the 6-minute walk distance (P<0.01) and 18 of them had symptomatic improvement. No significant changes were observed in echocardiograhic parameters, including right ventricular end-diastolic diameter, left ventricular end-diastolic diameter and volume, and tricuspid regurgitation peak velocity, except the left ventricular ejection fraction (P<0.05). Right heart catheterization showed significant increase in pulmonary-to-systemic flow (Qp/Qs) ratio (P<0.01) and significant decrease in pulmonary vascular resistance (P<0.05) and pulmonary-to-systemic vascular resistance (Rp/Rs) ratio. Simultaneous decrease in Qp/Qs ratio and increase in Rp/Rs ratio were found in 8 (24.2%) of the 33 patients. Adverse events were observed in seven patients, including headache in two patients, flushing in three patients, nasal congestion in one patient, and abnormal penile erection in one teenage male. Significant decreases of red blood cell count (P<0.01) and hemoglobin (P<0.01) accompanied by a mild increase of creatinine (P<0.05) were observed after the 6-month therapy. CONCLUSION: Six-month sildenafil therapy is well tolerated and the therapy markedly improves the exercise capacity and hemodynamics in most patients with severe PAH secondary to CHD.

参考文献/References

[1]Galiè N,Hoeper MM,Humbert M,et al.Guidelines for the diagnosis and treatment of pulmonary hypertension[J].Eur Respir J,2009,34(6):1219-1263.
[2]Yen CH,Leu S,Lin YC,et al.Sildenafil limits monocrotaline-induced pulmonary hypertension in rats through suppression of pulmonary vascular remodeling[J].J Cardiovasc Pharmacol,2010,55(6):574-584.
[3]Pepke-Zaba J,Gilbert C, Collings L,et al.Sildenafil improves health-related quality of life in patients with pulmonary arterial hypertension[J].Chest,2008,133(1):183-189.
[4]Nemoto S,Sasaki T,Ozawa H,et al. Oral sildenafil for persistent pulmonary hypertension early after congenital cardiac surgery in children[J].Eur J Cardiothorac Surg,2010,38(1):71-77.
[5]Barst RJ,Ivy DD,Gaitan G,et al.A randomized,double-blind, placebo-controlled,dose-ranging study of oral sildenafil citrate in treatment-naive children with pulmonary arterial hypertension[J].Circulation,2012,125(2):324-334.
[6]Tay EL,Papaphylactou M,Diller GP,et al.Quality of life and functional capacity can be improved in patients with Eisenmenger syndrome with oral sildenafil therapy[J].Int J Cardiol,2011, 149(3):372-376.
[7]Lu XL,Xiong CM,Shan GL,et al.Impact of sildenafil therapy on pulmonary arterial hypertension in adults with congenital heart disease[J].Cardiovasc Ther,2010,28(6):350-355.
[8]Zhang DZ,Zhu XY,Meng J,et al.Acute hemodynamic responses to adenosine and iloprost in patients with congenital heart defects and severe pulmonary arterial hypertension[J].Int J Cardiol,2011,147(3):433-437.
[9]Galiè N,Ghofrani HA,Torbicki A,et al.Sildenafil citrate therapy for pulmonary arterial hypertension[J].N Engl J Med,2005,353(20):2148-2157.
[10]Wirostko BM,Tressler C,Hwang LJ,et al.Ocular safety of sildenafil citrate when administered chronically for pulmonary arterial hypertension:results from phase III,randomised,double masked,placebo controlled trial and open label extension[J].BMJ,2012,344:e554.

备注/Memo

备注/Memo:
收稿日期：2012-03-18.
通讯作者：朱鲜阳，主任医师，主要从事结构性心脏病影像诊断和介入治疗 Email：xyangz@yahoo.com.cn
作者简介：张端珍，副主任医师，博士Email：meichengzhang123@163.com
更新日期/Last Update: 2012-11-16