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目的:探讨5型磷酸二酯酶(PDE5)抑制剂对特发性肺动脉高压(IPAH)患者预后的影响。方法:纳入2005-05至2009-08期间在我院本部肺血管病诊治中心住院并新诊断为IPAH的患者89例。根据患者是否接受PDE5抑制剂分为PDE5抑制剂组(52例)及对照组(37例)。通过回顾性查阅病历收集患者的基线资料,电话随访和(或)查阅患者门诊病历获取患者生存状态及治疗情况。结果:PDE5抑制剂组及对照组在年龄、性别、身高、体重、血压、心率、世界卫生组织(WHO)肺动脉高压功能分级、6分钟步行距离、血流动力学及接受基础治疗比例,差异均无统计学意义(P均>0.05)。对89例患者平均随访(20.12±14.69)月,随访期间26例患者死亡。PDE5抑制剂组1、2、3年生存率明显高于对照组,差异有统计学意义(P<0.05)。WHO肺动脉高压功能分级为Ⅲ/Ⅳ级的患者,PDE5抑制剂组1、2、3年生存率明显高于对照组,差异有统计学意义(P<0.05);WHO肺动脉高压功能分级为Ⅰ/Ⅱ级的患者,PDE5抑制剂组1、2、3年生存率较对照组有改善的趋势,但差异无统计学意义(P>0.05)。当未包括6分钟步行距离时,84例患者多因素COX分析结果显示:体重(风险比=0.944,P=0.047),混合静脉血氧饱和度(风险比=0.934,P=0.006),接受PDE5抑制剂治疗(风险比=0.314,P=0.006)三参数将有助于评估IPAH患者的预后。当纳入6分钟步行距离时(n=41),多因素COX分析显示年龄(风险比=0.860,P=0.004)、6分钟步行距离(风险比=0.984,P=0.001)及接受PDE5抑制剂治疗(风险比=0.072,P=0.001)三参数将有助于评估IPAH患者的预后。结论:PDE5抑制剂对改善IPAH患者的预后有益。
Objective: To investigate the effect of type 5 phosphodiesterase (PDE5) inhibitor on the prognosis of patients with idiopathic pulmonary hypertension (IPAH). Methods: A total of 89 patients were enrolled and newly diagnosed as IPAH during the period from May 2005 to 2009-08 in the department of pulmonary vascular disease diagnosis and treatment in our department. Patients were divided into PDE5 inhibitor group (n = 52) and control group (n = 37) according to whether they received PDE5 inhibitor or not. The patient’s survival status and treatment status were obtained by retrospectively reviewing the patient’s baseline data, telephone follow-up and / or consulting patient outpatient records. Results: The PDE5 inhibitor group and the control group had significant differences in age, sex, height, weight, blood pressure, heart rate, WHO pulmonary function classification, 6-minute walk distance, hemodynamics and the proportion of patients receiving basic treatment No statistical significance (P> 0.05). Totally 89 patients were followed up for an average of (20.12 ± 14.69) months, and 26 patients died during follow-up. The 1, 2, 3-year survival rates of PDE5 inhibitor group were significantly higher than those of the control group (P <0.05). The WHO 1, 2, 3-year survival rates were significantly higher in patients with grade III / IV pulmonary hypertension compared with those in the control group (P <0.05); WHO pulmonary hypertension grade Ⅰ / Patients in grade Ⅱ, PDE5 inhibitor group 1, 2, 3-year survival rate than the control group to improve the trend, but the difference was not statistically significant (P> 0.05). When the 6-minute walking distance was not included, the multivariate COX analysis of 84 patients showed that body weight (hazard ratio = 0.944, P = 0.047), mixed venous oxygen saturation (hazard ratio = 0.934, P = 0.006) Inhibitor therapy (hazard ratio = 0.314, P = 0.006) The three parameters will help to evaluate the prognosis of patients with IPAH. Multivariate COX analysis showed that age (hazard ratio = 0.860, P = 0.004), distance at 6-minute walk (hazard ratio = 0.984, P = 0.001) and treatment with PDE5 inhibitors were similar in 6-minute walking distances (n = 41) (Hazard ratio = 0.072, P = 0.001) The three parameters will help to assess the prognosis of patients with IPAH. Conclusions: PDE5 inhibitors are beneficial for improving the prognosis of patients with IPAH.