由陈绍良等进行的一项研究表明,在药物治疗反应不佳的特发性肺动脉高压(IPAH)患者中,肺动脉去神经术(PADN)可对功能能力和血流动力学指标产生积极影响。论文发表于7月的《美国心脏病学会杂志》(JACC)电子版。
此项研究共纳入21例对药物治疗反应不佳的IPAH患者,其中13例接受PADN治疗,另外8例拒绝PAND治疗的患者被分入对照组。在主肺动脉分叉以及左、右肺动脉开口处实施PADN。主要终点为随访3个月时肺动脉压、三尖瓣偏移(Tei)指数和6分钟步行距离(6MWT)变化。
结果显示,与对照组相比,随访3个月时PADN组患者的平均肺动脉显着降低(由55±5 mmHg降至36±5 mmHg,P<0.01),6MWT(由324±21 m增加至491±38 m,P<0.006)和Tei指数(由0.3±0.04升高至0.50±0.04,P<0.001)亦出现显着改善。(生物谷Bioon.com)
生物谷推荐英文摘要:
J Am Coll Cardiol doi:10.1016/j.jacc.2013.05.075
Pulmonary artery denervation to treat pulmonary arterial hypertension: a single-center, prospective, first-in-man PADN-1 study ONLINE FIRST
Shao-Liang Chen, MD, FACC; Feng-Fu Zhang, MD; Jing Xu, MD; Du-jiang Xie, MD; Ling Zhou, MD; Thach Nguyen, MD; Gregg W. Stone, MD, FACC
Objectives This study tested the safety and efficacy of pulmonary artery (PA) denervation (PADN) for patients with idiopathic pulmonary artery hypertension (IPAH) not responding optimally to medical therapy.
Background Baroreceptors and sympathetic nerve fibers are localized in or near the bifurcation area of the main PA. We previously demonstrated that PADN completely abolished the experimentally elevated PA pressure responses to occlusion of the left interlobar pulmonary artery.
Methods Out of a total of 21 patients with IPAH, 13 patients received the PADN procedure, the other 8 patients who refused the PADN procedure were assigned to the control group. PADN was performed at the bifurcation of the main PA, and at the ostial right and left PA. Serial echocardiography, right heart catheterization, and a 6-minute walk test (6MWT) were performed. The primary endpoints were the change of pulmonary artery pressure (PAP), tricuspid excursion (Tei) index, and 6MWT at 3-months follow-up.
Results Compared with the control group, at 3 months follow-up, the patients who underwent the PADN procedure showed significant reduction of mean PAP (from 55±5 mmHg to 36±5 mmHg, p<0.01), significant improvement of the 6MWT (from 324±21 m to 491±38 m, p<0.006) and of the Tei index (from 0.3±0.04 to 0.50±0.04, p<0.001).
Conclusion We report for the first time the effect of PADN on functional capacity and hemodynamics in patients with IPAH not responding optimally to medical therapy. Further randomized study is required to confirm the efficacy of PADN.Clinical trial ID: chiCTR-ONC-12002085