肺動脈高壓治療藥物之新進展

The Update of Drugs for Pulmonary Arterial Hypertension

許志新(Chih-Hsin Hsu)

《台灣醫學》 20卷2期 (2016/03) Pp. 158-166

https://doi.org/10.6320/FJM.2016.20(2).5

摘要

肺動脈高壓主要是因為內皮細胞功能異常引起血管放鬆與收縮不平衡，以及血管內皮細胞不正常的增殖，造成血管重塑、血管腔縮減，造成肺血管的阻力增加，使得肺動脈循環血流受限，進而造成肺動脈高壓，最終導致右心衰竭死亡。在過去因缺乏有效的藥物，預後相當不好。近年來，新的有效藥物不斷出現，只要病患早期診斷並適當用藥，就有機會改善預後。新一代藥物主要包括前列腺環素類似物(epoprostenol, treprostinil, iloprost)、內皮素受體拮抗劑(bosentan, ambrisentan, macitentan)以及磷酸二酯酵素抑制劑(sildenafil, tadalafil)三大類。在2013年，可溶性鳥苷酸環化酶促進劑(riociguat)也被納入肺高壓的治療。不只對於原發性肺高壓帶來療效，也對於慢性血栓相關之肺高壓有所助益。當選擇治療時，除了考慮給藥方式之外，副作用、個人對藥物的反應和感受、醫院和醫師對藥物的使用經驗，自我照護的能力與成本都是需要列入考慮的。

關鍵字

肺動脈高壓

並列摘要

Pulmonary arterial hypertension is characterized by a progressive rise in pulmonary vascular resistance resulting from vascular remodeling, vasoconstriction, and cellular proliferation. The progressive rise in pulmonary vascular resistance lead to right heart failure and death, the prognosis is poor without management. Currently, three classes of drugs are approved for the treatment of PAH based on results from clinical trials - prostacyclin analogues (epoprostenol, treprostinil, iloprost), endothelin receptor antagonists (bosentan, ambrisentan, macitentan) , and phosphodiesterase type 5 inhibitors (sildenafil, tadalafil) . Earlier diagnosis and aggressive front line treatment have led to considerable gains. Soluble guanylate cyclase stimulator (rociquat) have also approved for management of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension in 2013. The choice of drug may depend on a variety of factors including the approved status, the route of administration, the side effect, the patients’ preferences and risk, the physicians’ experience and the cost

並列關鍵字

pulmonary arterial hypertension

參考文獻

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