A comparative study of iloprost and sildenafil combined therapy and sequential treatment of pulmonary hypertension
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摘要: 目的:探究伊洛前列素、西地那非起始联合治疗与序贯治疗肺动脉高压(PAH)的效果。方法:选取2016-02—2019-02期间本院诊治的PAH患者60例,根据患者意愿及治疗方案分为起始联合治疗组22例(起始联合使用吸入伊洛前列素和西地那非)、序贯治疗A组20例(起始单用吸入伊洛前列素,后期添加西地那非)、序贯治疗B组18例(起始单用西地那非,后期添加吸入伊洛前列素),治疗24周。比较3组肺血流动力学、6 min步行距离(6 MWD)、Borg呼吸指数、氨基末端脑钠肽前体(NT-proBNP)、肝功能、不良反应及序贯治疗组联合用药情况。结果:重复测量方差分析显示,3组肺血流动力学、NT-proBNP、Borg呼吸指数、6 MWD的时点效应、组间效应、交互效应均显著(P<0.05)。治疗后,起始联合治疗组肺血流动力学(PASP、PVR、mPAP、PCWP)、NT-proBNP、Borg呼吸指数均低于序贯治疗A组、B组,6 MWD高于序贯治疗A组、B组,差异有统计学意义(P<0.05);而序贯治疗A组与B组上述指标比较差异无统计学意义(P>0.05)。3组治疗前后肝功能指标(ALT、AST、GGT)比较差异无统计学意义(P>0.05)。起始联合治疗组不良反应率高于序贯治疗组,但3组不良反应率比较差异无统计学意义(P>0.05)。序贯治疗A组与B组联合用药例数、治疗开始至需要联合用药的时间比较差异无统计学意义(P>0.05)。结论:伊洛前列素、西地那非两种序贯治疗方式效果相当,而起始联合治疗相比序贯治疗更利于改善PAH患者肺血流动力学,提高运动耐力,且安全性肯定。Abstract: Objective: To investigate the effect of initial combination therapy with iloprost and sildenafil on sequential treatment of pulmonary hypertension(PAH). Method: Sixty patients with PAH diagnosed in our hospital from February 2016 to February 2019 were enrolled. According to the patient's wishes and treatment plan, 22 patients were included in the initial combined treatment group(initial combined with inhaled iloprost and sildenafil). Sequential treatment group A 20 cases(initial single inhaled iloprost, late addition of sildenafil), sequential treatment group B 18 cases(start with sildenafil, Late inhalation of iloprost), treated for 24 weeks. Three groups of pulmonary hemodynamics, 6-minute walking distance(6 MWD), Borg respiratory index, amino-terminal pro-brain natriuretic peptide(NT-proBNP), liver function, adverse reactions, and sequential treatment groups were compared. Result: Repeated measures analysis of variance showed that the three groups of pulmonary hemodynamics, NT-proBNP, Borg respiratory index, 6 MWD time-point effect, inter-group effect, and interaction effects were significant(P<0.05). After treatment, pulmonary hemodynamics(PASP, PVR, mPAP, PCWP), NT-proBNP, and Borg respiratory index were lower in the initial combination group than in the sequential treatment group A and B, and 6 MWD was higher than the sequential treatment group A. There was a statistically significant difference between the two groups(P<0.05). There was no significant difference between the sequential treatment group A and group B(P>0.05). There were no significant differences in liver function indexes(ALT, AST, GGT) between the three groups before and after treatment(P>0.05). The adverse reaction rate in the initial combined treatment group was higher than that in the sequential treatment group, but there was no significant difference in the adverse reaction rates between the three groups(P>0.05). There was no significant difference in the number of consecutive treatments between group A and group B, and the time from the start of treatment to the need for combination therapy(P>0.05).Conclusion: The two sequential treatments of iloprost and sildenafil are equally effective, and the initial combination therapy is more effective than sequential therapy in improving pulmonary hemodynamics, improving exercise tolerance, and safety in patients with PAH.
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Key words:
- pulmonary hypertension /
- iloprost /
- sildenafil /
- initial combination /
- sequential therapy
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