国产阿托伐他汀钙治疗肺动脉高压的初步疗效观察

目的评价国产阿托伐他汀钙治疗肺动脉高压（PAH）的疗效，探讨其疗效的作用机制。方法选择2008年1月至2012年1月在我院住院的52例PAH患者：包括先天性体肺分流导致的PAH（CAD—PAH）28例、特发性PAH（IPAH）16例．结缔组织病相关的PAH（CTD—PAH）8例。将患者随机分为对照组和观察组：两组患者均给予常规治疗，观察组在常规治疗基础上加用国产阿托伐他汀钙口服，20mg／d。分别观察治疗前、治疗6个月后患者的平均肺动脉压（mPAP）、动脉血气分析指标（PaO，）、超声心动图观察右室内径的变化（RVD）；测定6min步行试验距离（6MWD）、血肌酸激酶（CK）及转氨酶（ALT／AST）的变化。结果（1）观察组患者治疗6个月后mPAP较治疗前及对照组有所降低（P〈0．05）；（2）治疗后两组患者PaO，升高，且观察组升高更明显，（P〈0．01，P〈0．05）；（3）治疗后RVD无明显缩小（P〉0，05）；（4）两组患者治疗后6MWD均有所延长，但两组比较差异无统计学意义（P〉·0．05）；（5）所有患者未出现明显不良反应，如肌肉痛、肌酶及转氨酶升高等（P〉0．05）。结论国产阿托伐他汀钙治疗6个月后能使PAH患者mPAP有所下降，血氧饱和度升高；但右室内径无明显缩小、运动耐量提高不明显。估计与样本量较小，治疗观察时间过短有关，长期疗效尚需进一步研究。

Preliminary observation of clinical effect of domestic atorvastatin on patients with pulmonary arterial hypertension

Objective To explore the effect of domestic Atorvastatin on patients with Pulmonary Arterial Hypertension （PAH） and its mechanism. Methods From January 2008 to January 2012, a total of 52 inpatients with PAH in our hospital were enrolled, including 28 patients with PAH induced by pulmonary shunt （CAD-PAH）, 16 patients with idiopathic PAH （IPAH）, and 16 patients with PAH related with connective tissue diseases（CTD-PAH）. All patients were randomly and equally divided into control group （conventional therapy） and observation group （conventional therapy and domestic Atorvastatin, 20 mg/d）. Mean pulmonary arterial pressure （mPAP）, arterial blood gas analysis （PaO2 ）, echocardiography changes in fight ventricular diameter （RVD）, 6 Minutes Walking distance （6MWD）, ereatine kinase （CK） and transaminases （ALT/AST） were measured before treatment and 6 months after the treatment. Results （ 1 ） After 6 months treatment, mPAP in the observation group was lower than that in the control group and that before the treatment （P 〈 0.05 ）. （2） After treatment, PaO 2 in both group was higher than that before treatment, and the improvement was more obvious in the control group（P 〈0. O1 ,P 〈0.05）. （3） There was no significant difference in RVD before and after treatment （P 〉0.05）. （4） 6MWD in the two groups was increased after treatment, but there was no significant difference between two groups （P 〉 O. 05 ）. （5） No adverse reactions such as muscle pain and increase of CK and ALT/AST were reported （P 〉 0.05）. Conclusions Domestic Atorvastatin can decrease mPAP and increase PaO2 in PAH patients after six-month treatment. Yet the improvement of RVD and exercise capacity were not obvious, which might be related to the small . sample size and the short-term observation on treatment. Further investigation is expected to explore the long-term effect of domestic Atorvastatin.