CAJ | 학술논문

目的：研究高选择性内皮素受体A型拮抗剂安立生坦对肺动脉高压患者近期疗效和安全性的初步观察。方法回顾性分析2012.12-2013.08武汉亚洲心脏病医院肺高压中心特发性肺高压5例，结缔组织病相关性肺高压2例共7例患者，口服安立生坦5mg每日一次，连续服用24周。分别于安立生坦治疗前及治疗24周进行右心导管、心脏超声、患者WHO FC分级、6MWT及查静脉血测NT-proBNP及肝功能(丙氨酸转氨酶，ALT)。结果安立生坦治疗24周时，右心导管检查全肺阻力由(1899±753)dyn.s-1.cm-5降为(1005±642)dyn.s-1. cm-5(p=0.03)。超声心动图测得右室EF值由934±7)%增为(41±8)%(P=0.043)。治疗前WHO FC Ⅲ-IV级患者为5例，治疗后为1例，较前减少(p=0.03)。6MWT由(419±26)m增加为(508±28)m(P=0.001)。NT-proBNP由(235±164)ng/L下降至(147±129)ng/L(P=0.014)。24周内7例患者无死亡及病情恶化，无患者出现转氨酶异常。结论安立生坦可明显降低肺血管阻力，改善患者心功能，提高运动耐量，降低NT-proBNP水平，且对右室EF值有改善，并且安全性，耐受性良好。
목적：연구고선택성내피소수체A형길항제안립생탄대폐동맥고압환자근기료효화안전성적초보관찰。방법회고성분석2012.12-2013.08무한아주심장병의원폐고압중심특발성폐고압5례，결체조직병상관성폐고압2례공7례환자，구복안립생탄5mg매일일차，련속복용24주。분별우안립생탄치료전급치료24주진행우심도관、심장초성、환자WHO FC분급、6MWT급사정맥혈측NT-proBNP급간공능(병안산전안매，ALT)。결과안립생탄치료24주시，우심도관검사전폐조력유(1899±753)dyn.s-1.cm-5강위(1005±642)dyn.s-1. cm-5(p=0.03)。초성심동도측득우실EF치유934±7)%증위(41±8)%(P=0.043)。치료전WHO FC Ⅲ-IV급환자위5례，치료후위1례，교전감소(p=0.03)。6MWT유(419±26)m증가위(508±28)m(P=0.001)。NT-proBNP유(235±164)ng/L하강지(147±129)ng/L(P=0.014)。24주내7례환자무사망급병정악화，무환자출현전안매이상。결론안립생탄가명현강저폐혈관조력，개선환자심공능，제고운동내량，강저NT-proBNP수평，차대우실EF치유개선，병차안전성，내수성량호。
Objective To investigate the preliminary efficacy and safety of ambrisentan in patients with pulmonary arterial hypertension(PAH), which is a selective endothelin receptor antagonist.Methods 7 patients with PAH hospitalized at Wu Han Asia Heart Hospital from Dec.2012 to Aug.2013 which included 5 patients with idiopathic PAH and 2 patients with associated connective-tissue disease were retrospectively analyzed, and they all received 5 mg of ambrisentan once daily for 24 weeks.Before and after 24 weeks treatment, their right heart catheterization examination, echocardiography, WHO functional classification (WHO-FC),6-minute walk test(6-MWD)and (NT-proBNP) were evaluated.Results After 24 weeks treatment,the total pulmonary resistance measured by right heart catheterization decreased from (1899±753) dyn.s-1.cm-5 to (1005±642)dyn.s-1.cm-5 (p=0.03). Right ventricular ejection fraction measured by echocardiography increased from (34±7)% to (41±8)% (P=0.043).The 6-MWT decreased from (419±26)m to (508±28)m(P=0.014).And NT-proBNP decreased (235±164) ng/L to (147±129)ng/L(P=0.014).In these 24 weeks,there were no disease progression and death, and aminotransferase abnormalities in these 7 patients.Conclusions Ambrisentan treatment can significantly improve the cardiac function,exercise capacity,right ventricular ejection fraction and reduce the NT-proBNP level in PAH patients.Meanwhile, Ambrisentan is also safe and could be well tolerated in PAH patients.