2020 年第 12 期 第 15 卷

前列地尔对慢性阻塞性肺疾病合并肺动脉高压患者肺血管顺应性和血管内皮功能的影响

Effect of alprostadil on pulmonary vascular compliance and vascular endothelial function in patients with chronic obstructive pulmonary disease and pulmonary hypertension 

作者：李欢吉训恋

英文作者：Li Huan Ji Xunlian

单位：海口市人民医院药学部570208

英文单位：Department of Pharmacy Haikou People′s Hospital Haikou 570208 China

关键词：慢性阻塞性肺疾病；前列地尔；肺动脉高压；肺血管顺应性；血管内皮功能

英文关键词：Chronicobstructivepulmonarydisease;Alprostadil;Pulmonaryhypertension;Pulmonaryvascularcompliance;Vascularendothelialfunction

• 摘要：

• 目的 探究前列地尔对慢性阻塞性肺疾病（COPD）合并肺动脉高压（PH）患者肺血管顺应性（Cpv）和血管内皮功能的影响。方法  选择2017年9月至2018年10月于海口市人民医院呼吸科住院治疗的COPD合并PH患者108例纳入研究，按照随机数字表法分为观察组及对照组，每组54例。2组患者均给予常规治疗，观察组在常规治疗基础上给予前列地尔治疗，2组均连续治疗10 d。比较2组治疗前后平均肺动脉压（mPAP）、血气指标、肺功能指标及Cpv、肺血管总阻力（TPR）、血清内皮素1、一氧化氮等指标水平。分析血管顺应性指标、血管内皮因子水平与肺动脉压力的相关性。结果   ①治疗后2组患者动脉血氧分压、动脉血氧饱和度及第1秒用力呼气容积/用力肺活量比值均高于治疗前，且观察组高于对照组；mPAP、动脉血二氧化碳分压均低于治疗前，且观察组低于对照组（均P<0.05）。②治疗后2组Cpv、一氧化氮水平均高于治疗前，且观察组高于对照组［（27.9±3.0）ml/kPa比（25.7±2.5）ml/kPa、（72±10）μmol/L比（68±8）μmol/L］；TPR、内皮素1水平均低于治疗前，且观察组低于对照组［（26±5）kPa·s/L比（31±4）kPa·s/L、（60±7）ng/L比（64±6）ng/L］，差异均有统计学意义（均P<0.05）。③Pearson相关性分析结果显示，mPAP与Cpv呈负相关（r=-0.712，P<0.001），与TPR、内皮素1呈正相关（r=0.758、0.701，均P<0.001）。结论  前列地尔可显著改善COPD合并PH患者肺动脉压力、肺通气功能，其机制可能与其改善Cpv及血管内皮功能相关。

• Objective  To investigate the effect of alprostadil on pulmonary vascular compliance(Cpv) and vascular endothelial function in patients with chronic obstructive pulmonary disease(COPD) combined with pulmonary hypertension(PH). Methods From September 2017 to October 2018，108 patients with COPD complicated with PH admitted to Department of Respiratory, Haikou People′s Hospital were enrolled. They were divided into observation group and control group by random number table method, with 54 cases in each group. Routine treatment was given to both groups. The observation group was given alprostadil on the basis of routine treatment. Mean pulmonary artery pressure(mPAP), blood gas indexes, lung function indexes and Cpv, total pulmonary resistance (TPR), levels of serum endothelin-1(ET-1) and nitric oxide(NO) levels were compared before and after treatment in two groups. The correlation among vascular compliance index, vascular endothelial factor and pulmonary artery pressure was analyzed. Results ①After treatment, arterial oxygen partial pressure(PaO2), oxygen saturation(SaO2), forced exhalation per second in 1 s(FEV1)/forced vital capacity(FVC) in both groups were significantly higher than those before treatment, which in the observation group were higher than those in the control group; while mPAP and arterial carbon dioxide partial pressure(PaCO2) were significantly lower than those before treatment, which in the observation group were lower than those in the control group(all P<0.05). ②After treatment, Cpv and NO levels in both groups were higher than those before treatment, which in the observation group were higher than those in the control group［（27.9±3.0）ml/kPa vs （25.7±2.5）ml/kPa,  （72±10）μmol/L vs （68±8）μmol/L］; the levels of TPR and ET-1 were lower than those before treatment, which in the observation group were lower than those in the control group［（26±5）kPa·s/L vs （31±4）kPa·s/L, （60±7）ng/L vs （64±6）ng/L］（all P<0.05）. ③Pearson correlation analysis showed that mPAP was negatively correlated with Cpv(r=-0.712, P<0.001), and positively correlated with TPR and ET-1(r=0.758, 0.701, both P<0.001). Conclusion Alprostadil can significantly improve pulmonary artery pressure, pulmonary ventilation function of patients with COPD combined with PH through improving Cpv and vascular endothelial function.