肺動脈高壓之治療策略及療效評估

肺動脈高壓在過去的二十年內有了長足的進步。隨著愈來愈多的研究被發表和討論，對於治療策略與目標漸漸的有了相當程度的改變，也有更強的臨床證據支持。報告顯示在疾病一開始便積極的給予治療，有助於改善長期預後。儘管在死亡率的好處尚未達到統計上的差異，接續性合併(sequential combination)治療或起始合併(upfront combination)治療大多能實質改善臨床上的惡化。為了達到更好的預後，現在已經不再建議當臨床惡化才決定調整治療的強度，而是建議利用相關的治療標的(goals)或評估或計分表來建立目標導向式(goal-oriented)的治療。

關鍵字

肺動脈高壓；治療；療效

並列摘要

The knowledge of pulmonary arterial hypertension (PAH) has been substantially advanced in the past two decades. With the growing body of clinical evidence, treatment strategies and goals have been evolving considerably and have become more evidence-based. Early intervention with PAH-specific agents has been shown to improve long-term outcome. Besides, both sequential combination and upfront combination strategies are supported by many reports in terms of clinical worsening, though the mortality benefit has yet failed to reach statistical significance. To achieve better outcomes, the goal-oriented therapy according to a panel of treatment targets, rather than the clinical worsening oriented therapy, is more recommended.

並列關鍵字

pulmonary arterial hypertension ； treatment ； outcome

參考文獻

alie N, Humbert M, Vachiery JL, et al: 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).Eur Heart J 2016;37:67-119. doi: 10.1093/eurheartj/ehv317

'Alonzo GE, Barst RJ, Ayres SM, et al: Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann Intern Med 1991;115:343-9. doi: 10.7326/0003-4819-115-5-343

abib G, Torbicki A: The role of echocardiography in the diagnosis and management of patients with pulmonary hypertension. Eur Respir Rev 2010;19:288-99. doi: 10.1183/09059180.00008110

aliè N, Hoeper MM, Humbert M, et al: Guidelines for the diagnosis and treatment of pulmonary hypertension. European Respiratory Journal 2009;34:1219-63.

cLaughlin VV, Badesch DB, Delcroix M, et al: End points and clinical trial design in pulmonary arterial hypertension. J Am Coll Cardiol 2009;54: S97-107. doi: 10.1016/j.jacc.2009.04.007

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肺動脈高壓之治療策略及療效評估

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