阿托伐他汀对低氧性肺动脉压的影响

目的研究他汀类药物治疗慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）合并肺动脉高压（pulmonary hypertension,PH）的疗效和机制。方法选择2007年1月至2010年5月在我院诊治的COPD合并PH 100例,随机分为治疗组和对照组各50例。对照组给予常规治疗;治疗组在常规治疗基础上加用阿托伐他汀,首剂10～20 mg/d,若无不良反应,则维持剂量10 mg/d,疗程6个月,观察一氧化氮（nitric oxide,NO）、内皮素（endotheli,ET）、肺动脉收缩压（pulmonary artery systolicpressure,PAP）、6分钟步行距离（6-minute walking distance6,MWD）的变化。结果治疗后,两组6MWD、NO较治疗前升高,PAP、ET降低,差异有统计学意义（P〈0.01）,但治疗组较对照组更明显,差异有统计学意义（P〈0.01）。Spearman相关分析：ET与PAP呈正相关（r=0.452）,NO数值与PAP呈负相关（r=-0.557）。结论阿托伐他汀能降低COPD合并PH患者肺动脉压,改善患者心肺功能及运动耐量。其机制可能与阿托伐他汀能增加NO含量,降低ET的分泌,改善内皮功能有关。

Effects of atorvastatin on pulmonary hypertension in chronic obstructive pulmonary disease

Objective To observe the effects and mechanism of atorvastatin treatment on patients with chronic obstructive pulmonary disease（COPD） combining with pulmonary hypertension（PH）.Methods One hundred patients with COPD combining with PH from January 2007 to May 2010 were assigned randomly to two groups： treatment group（n=50） and control group（n=50）.Patients in the control group were given with oxygen therapy,vasodilator,anticoagulant,anti-infection and so on.Patients in the treatment group were given with atorvastatin in addition to the treatment on control group for 6 months.The first dose was 10-20 mg/d and sustained dose was 10 mg/d.The changes of PAP,6MWD,NO,and ET were measured.Results After 6 month treatment,ET,PAP in the two groups decreased significantly（all P0.01） while NO,6MWD increased significantly（all P0.01）.However,the change of the indexes in treatment group was more obvious than that in control group.Conclusion Atorvastatin can reduce PAP and improve exercise tolerance of COPD patients combining with PH.The mechanism may be that atorvastatin can reduce ET,improve NO and the function of vascular endothelial.