波生坦治疗婴儿先心病合并肺动脉高压的临床观察

doi:10.6040/j.issn.1671-7554.0.2015.743

摘要/Abstract

摘要： 目的探讨波生坦治疗3月龄以下小婴儿先天性心脏病相关性肺动脉高压(CHD-PAH)有效性及安全性。方法选择2012年1月至2013年12月在山东大学齐鲁医院和齐鲁儿童医院治疗的3月龄以下CHD-PAH患儿60例,随机分为波生坦组和卡托普利组,每组30例;同期选择年龄3个月以下健康查体婴儿30例(正常对照组)。采用ELISA法、超声心动图检测波生坦组、卡托普利组和对照组治疗前、治疗后4、8周血浆内皮素-1(ET-1)水平及平均肺动脉压(mPAP)的变化;检测波生坦组和卡托普利组治疗前、后肝酶变化;通过60 mL奶液喂养时间的变化评估患儿运动耐量。结果波生坦组和卡托普利组治疗前血浆ET-1含量、mPAP较正常对照组明显升高(P<0.05 );波生坦组治疗后4、8周 mPAP及血浆ET-1水平较治疗前明显下降(P<0.01),卡托普利组治疗后 mPAP较治疗前下降(P<0.05),血浆ET-1水平无明显变化;波生坦组与卡托普利组治疗后4、8周血浆ET-1含量及mPAP比较明显下降(P<0.05);波生坦组治疗前后肝酶差异无统计学意义(P>0.05);波生坦组治疗后4周60 mL奶液喂养时间较治疗前明显缩短(P<0.01)。结论波生坦可有效降低先心病患儿平均肺动脉压,提高运动耐量。短期应用波生坦治疗小婴儿先天性心脏病相关性肺动脉高压安全、有效。

关键词: 波生坦, 婴儿, 先天性心脏病, 肺动脉高压, 内皮素-1

Abstract: Objectives To explore the efficacy and safety of bosentan in the treatment of infants(<3 months)with congenital heart disease complicated with pulmonary hypertension(CHD-PAH). Methods A total of 60 CHD-PAH infants treated in Qilu Hospital of Shandong University and Qilu Childrens Hospital during Jan. 2012 and Dec. 2013 were selected as the observation group and subdivided into bosentan group(n=30)and captopril group(n=30), another 30 healthy infants served as the control group. Endothelin-1(ET-1)and mean pulmonary arterial pressure(mPAP)before treatment, 4 and 8 weeks after treatment were measured with ELISA and echocardiography(UCG)in all infants. Changes of liver enzymes were measured before and after the treatment, and exercise tolerance was evaluated by observing the time changes of feeding 60 mL milk for babies in the observation group. Results ET-1 and mPAP were significantly higher in the observation group than in the control group(P<0.05). ET-1 and mPAP 4 and 8 weeks after bosentan treatment decreased significantly compared to the basement levels(P<0.01). MPAP after captopril treatment declined compared with the control group(P<0.05), while there was no statistical difference in ET-1 concentrations. ET-1 and mPAP in 山东大学学报 (医学版)54卷2期 -潘艳艳,等.波生坦治疗婴儿先心病合并肺动脉高压的临床观察 \=-the bosentan treatment group decreased significantly compared with those of the captopril group 4 weeks and 8 weeks after treatment(P<0.05). There was no difference in liver enzymes before and after bosentan treatment(P>0.05). The feeding time of 60 mL milk decreased statistically 4 weeks after bosentan treatment. Conclusion Bosentan can not only effectively decrease the mean pulmonary artery pressure of infants with congenital heart disease, but also improve their exercise tolerance. Bosentan is effective and safe in the treatment of CHD-PAH infants.

Key words: Infant, Hypertension pulmonary, Bosentan, Congenital heart disease, Endothelin-1

中图分类号:

R543.2

潘艳艳,孙永超,赵翠芬,孔清玉. 波生坦治疗婴儿先心病合并肺动脉高压的临床观察[J]. 山东大学学报（医学版）, 2016, 54(2): 53-56.

PAN Yanyan, SUN Yongchao, ZHAO Cuifen, KONG Qingyu. Clinical efficacy of bosentan in the treatment of babies with congenital heart disease complicated with pulmonary hypertension[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(2): 53-56.

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