N端脑钠肽原对西地那非联合辛伐他汀治疗女性肺动脉高压的评估

目的:探讨血浆N端脑钠肽原(NT-pro-BNP)对西地那非联合辛伐他汀治疗女性肺动脉高压患者疗效的评估情况。方法:将115例女性肺动脉高压患者分为西地那非联合辛伐他汀组(A组)38例(西地那非50mg,每日3次,辛伐他汀40mg,每日1次);西地那非组(B组)38例(西地那非50mg,每日3次);传统治疗组(C组)40例。连续治疗3个月,治疗前后测定右室收缩压、右室内径、肺功能[观察指标为第1秒用力呼气容积(FEV1)占用力肺活量(FVC)的百分比(FEV1/FVC)]、动脉血氧分压、6min步行距离(6-MWD)、明尼苏达心力衰竭生活质量(MLHFQ)评分及血浆NT-pro-BNP水平。结果:与C组比较,A、B组NT-Pro-BNP水平、右室收缩压及MLHFQ评分治疗后明显下降,FEV1/FVC及6-MWD较治疗前明显增加,且A组变化较B组更加显著;治疗后,A、B两组右室内径缩小、FEV1增加及动脉血氧分压提高,但A组并未显示出额外获益;血浆NT-Pro-BNP水平与右室收缩压呈正相关(r=0.72,P=0.003),与MLHFQ评分成正相关(r=0.47,P=0.007),与动脉血氧分压呈负相关(r=-0.57,P=0.013),与6-MWD亦呈负相关(r=-0.61,P=0.004)。结论:对西地那非联合辛伐他汀治疗多种病因所致的女性肺动脉高压,NT-pro-BNP可作为评估其疗效的一项简易、无创、可靠的生化指标。

N-terminal pro-brain natriuretic peptide in the evaluation of sildenafil and simvastatin combination treatment in female patients with pulmonary hypertension

Objective:To investigate the value of N-terminal pro-brain natriuretic peptide(NT-Pro-BNP) in the assessment of combining sildenafil with simvastain treatment in female patients with pulmonary hypertension.Method:One hundred and fifteen female patients with pulmonary hypertension were allocated randomly into three groups: sildenafil and simvastatin group(group A,n=38) treated with sildenafil 50 mg,tid and simvastatin 40 mg,qd;sildenafil group(group B,n=37) treated with sildenafil 50 mg,tid and regular treatment group(group C,n=40).Right ventricular systolic pressure(RVSP),right ventricular diameter,lung function,arterial oxygen pressure(PaO2),6 minute walk distance(6-MWD),Minnesota Living with Heart Failure Questionnaire(MLHFQ) scoring and plasma NT-Pro-BNP concentration were recorded at baseline and after 12 weeks under treatment.Result:At week 12,compared with group C,NT-Pro-BNP level,RVSP and MLHFQ scoring were decreased,FEV1/FVC and 6-MWD were increased in group A and B,and the effect in group A was greater than that in group B;right ventricle diameter was reduced,FEV1 and PaO2 were higher in group A and B,but little effect was enhanced in group A.Correlation analysis indicated that NT-Pro-BNP was inversely correlated with PaO2(r=-0.57,P=0.013) and 6-MWD(r=-0.61,P=0.004),positive correlations were observed with RVSP(r=0.72,P=0.003) and MLHFQ scoring(r=0.47,P=0.007).Conclusion:NT-Pro-BNP could be used as a simple,noninvasive and reliable biomarker to evaluate the effect of sildenafil and simvastatin combination treatment in female patients with pulmonary hypertension caused by different causes.