法舒地尔对老年慢性阻塞性肺疾病合并肺动脉高压的随机对照研究

摘要

Objective To investigate the clinical efficacy and safety of fasudil on patients with chronic ob-structive pulmonary disease( COPD) with pulmonary arterial hypertension( PAH) and the influence on plasma cytokines interleukin-l(IL-1),interleukin-6(IL-6)and endothelin-1(ET-1). Methods Ninety patients were randomly divided in-to treatment group(n=45) and control group(n=45). Patients in treatment group received fasudil injection 20 mL+5% glucose injection 250 mL,iv gtt,q24h,patients in control group were given normal saline 20 mL+5% glucose in-jection 250 mL,iv gtt,q24h. The two groups were treated for 15 days on the basis of basic therapy. The partial pressure of oxygen(PaO2),arterial oxygen saturation(SaO2),mean pulmonary arterial pressure(mPAP)and 6 minute walking distance(6MWD),IL-1,IL-6,ET-1 were detected before and after treatment. Results The treatment group got a sig-nificant improvement on PaO2,SaO2,mPAP,6MWD and a lower level of IL-1,IL-6 and ET-1 after treatment(P <0. 05). Compared with control group,lower level of IL-1,IL-6 and ET-1 were observed in the treatment group(P <0. 05 ) . Conclusion Treatment of fasudil in patients with COPD complicated with PAH achieved better curative effect than control group,which might be correlated with IL-1,IL-6 and ET-1.%目的：评价法舒地尔对慢性阻塞性肺疾病( COPD)合并肺动脉高压( PAH)的临床疗效、安全性及其对血浆细胞因子白介素-1(IL-1)、白介素-6(IL-6)及内皮素-1(ET-1)表达的影响。方法将90例COPD合并PH患者随机分为治疗组和对照组,每组45例,进行随机对照临床试验。治疗组在基础治疗的基础上,用法舒地尔注射液20 mL+5%葡萄糖注射液250 mL,iv gtt,q24h治疗；对照组在基础治疗的基础上,给予生理盐水20 mL+5%葡萄糖注射液250 mL,iv gtt,q24h治疗,两组疗程均为15 d。观察两组患者在治疗初始以及治疗15 d动脉氧分压(PaO2)、动脉血氧饱和度(SaO2)、平均肺动脉压(mPAP)及6 min步行试验变化、治疗有效率；采用ELISA法测定两组患者在治疗初始以及治疗15 d血清IL-1、IL-6、ET-1值的变化。结果治疗组PaO2、SaO2、平均肺动脉压、6 min步行试验改善情况明显优于对照组,差异有统计学意义( P<0．05)；且治疗组IL-1、IL-6、ET-1浓度明显低于治疗前(P<0．05)；治疗组IL-1、IL-6、ET-1浓度明显低于对照组(P<0．05)。结论法舒地尔注射液治疗COPD合并PAH患者的临床疗效明显优于对照组,且未发现明显毒副作用,其作用机制可能与法舒地尔注射液能有效降低COPD合并PAH患者血浆IL-1、IL-6及ET-1的水平有关。