川芎嗪对慢性阻塞性肺疾病急性加重期肺动脉高压的影响

Effect of Tetramethylpyrazine on Pulmonary Artery Hypertension in Patients with Chronic Obstructive Pulmonary Disease at Acute Exacerbation

摘要:

目的: 观察川芎嗪对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性加重期肺动脉高压的影响。 方法: 选取COPD并肺动脉高压(pulmonary hypertension,PH)急性加重期患者76例,随机分为川芎嗪组和对照组各38例。两组均给予基础治疗+前列地尔,川芎嗪组在此基础上加用盐酸川芎嗪注射液120 mg+5%葡萄糖液250 mL, 静脉滴注,1次/d。两组均治疗14 d。同时选择门诊体检正常者40例为健康组。检测两组患者治疗前后和健康组的血气分析指标[动脉血氧分压(PaO₂)、动脉血氧饱和度(SaO₂)]、血流动力学指标 、血管活性因子指标 。 结果: 治疗前,两组患者的8项指标(PaO₂,SaO₂,LVEF,PASP,PADP,MPAP,ET-1,NO)与健康组比较差异有统计学意义(P<0.01),两组患者无统计学差异;治疗14 d后,两组患者的8项指标均较治疗前显著改善(P<0.05或 P<0.01),但川芎嗪组患者的改善更显著 (P<0.05或 P<0.01); 川芎嗪组患者未发生与川芎嗪相关的不良反应。 结论: 川芎嗪治疗慢性阻塞性肺疾病急性加重期并肺动脉高压安全有效,其机制可能是通过选择性作用于肺血管,抑制ET-1而增加NO的合成和释放,从而降低肺动脉高压,改善心肺功能。

Abstract:

Objective: To investigate the effect of tetramethylpyrazine on pulmonary artery hypertension in patients with chronic obstructive pulmonary disease at acute exacerbation. Method: Seventy-six patients with chronic obstructive pulmonary disease at acute exacerbation and pulmonary artery hypertension were randomly divided into two groups: the tetramethylpyrazine group and the control group (n=38 each). Basic routine therapy plus alprostadil was given to underlying diseases of both groups, Beside this basis, patients in the tetramethylpyrazine group were given tetramethylpyrazine injection 120 mg plus 5% glucose solution, intravenous infusion, once a day. Continuous medication lasted 14 days in both groups. Forty normal persons in outpatient were chosen as the health group. Blood gas analysis indicators, including partial pressure of oxygen in artery (PaO₂) and blood oxygen saturation (SaO₂); hemodynamic indicators, including left ventricular ejection fraction (LVEF), pulmonary artery systolic pressure (PASP), pulmonary artery diastolic pressure (PADP), mean pulmonary artery pressure (MPAP); biochemical indicators, including endothelin-1 (ET-1) and nitric oxide (NO) were detected in the health group and in both groups before and after treatment. Result: Before the treatment, there were significant differences in eight indicators (PaO₂, SaO₂, LVEF, PASP, PADP, MPAP, ET-1, NO) between the two groups and the health group (P<0.01), there were no significant difference in eight indicators of two groups. After 14 days, eight indicators had significantly improved compared with before treatment in patients of the two groups (P<0.05 or P<0.01), however patients in the tetramethylpyrazine group improved more significantly (P<0.05 or P<0.01). There were no adverse reactions associated with tetramethylpyrazine. Conclusion: It was safe and effective that tetramethylpyrazine for the treatment of patients with chronic obstructive pulmonary disease and pulmonary artery hypertension. The possible mechanism is likely related with inhibiting of the vasoconstrictor ET-1 and increasing in vasodilator factor NO to reduce pulmonary artery hypertension.