systhiperСистемные гипертензииSystemic Hypertension2075-082X2542-2189LLC «ИнтерМедсервис»systhiper-369Research ArticleКАРДИОПУЛЬМОНОЛОГИЯВлияние силденафила на клинические проявления и гемодинамические показатели у больных легочной артериальной гипертензией, ассоциированной с системными ревматическими заболеваниямиEffect of sildenafil on clinical evidence and hemodynamic parameters in patients with pulmonary arterial hypertension, associated withsystemic rheumaticdiseasesВолковА. В.VolkovA. V.sandyvlk@yahoo.comЮдкинаН. Н.UdkinaN. N.natudkina@mail.ruКурмуковИ. А.KurmukovI. A.noemail@neicon.ruНиколаеваЕ. В.NikolaevaYe. A.noemail@neicon.ruНасоновЕ. Л.NasonovYe. L.noemail@neicon.ruФГБУ НИИ ревматологии им. В.А.Насоновой РАМН, МоскваРоссия2014231220221136166Copyright © Волков А.В., Юдкина Н.Н., Курмуков И.А., Николаева Е.В., Насонов Е.Л., 20222022Волков А.В., Юдкина Н.Н., Курмуков И.А., Николаева Е.В., Насонов Е.Л.Volkov A.V., Udkina N.N., Kurmukov I.A., Nikolaeva Y.A., Nasonov Y.L.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.syst-hypertension.ru/jour/article/view/369

Актуальность. Легочная артериальная гипертензия (ЛАГ) при системных ревматических заболеваниях (СРЗ), в частности при системной склеродермии, отличается прогрессирующим течением и неблагоприятным исходом, особенно при отсутствии адекватной терапии. Силденафил 20 мг для применения у пациентов с ЛАГ обладает мощным вазодилатирующими антипролиферативным действием.Цель работы - оценить эффективность и безопасность силденафила у пациентов с ЛАГ, ассоциированной с СРЗ. Материал и методы. Проведена 16-недельная терапия у 14 пациентов с ЛАГ на фоне системной склеродермии (12 человек) и системной красной волчанки (2 человека). Эффективность оценивалась по динамике клинико-лабораторных показателей, центральная гемодинамика оценивалась при катетеризации правых отделов сердца до исследования и через 16 нед терапии. Результаты. На фоне терапии отмечалось увеличение дистанции в тесте 6-минутной ходьбы на 31 м, а также улучшение функционального класса у 29% больных. Более значимое улучшение достигнуто при оценке гемодинамических параметров.Определялось достоверное снижение среднего давления в легочной артерии с 50,4±9,2 до 40,7±10,2 мм рт. ст. (p=0,002), легочного сосудистого сопротивления - с 9,5±5,9 до 6,4±3,7 единиц Вуда (p=0,05), а также некоторых других показателей. Давление в правом предсердии снизилось с 8,3±5,5 до 6,5±3,1 мм рт. ст., отмечалась стабилизация показателей систолической функции левого желудочка - сердечный индекс у всех 14 пациентов в течение исследования не подвергался существенным изменениям(3,1±0,9 л/мин/м2 в начале исследования, 3,1±0,7 л/мин/м2 через 16 нед терапии). Уровень риска по шкале регистра REVEALдостоверно снизился с умеренно высокого (9,0±2,0) до среднего (8,2±1,9); p=0,04.За время 16-недельной терапии силденафилом не было отмечено серьезных нежелательных явлений. У 3 пациентов отмечалась склонность к гипотензии, однако в целом по группе артериальное давление снижалось в рамках нормальных значений. Кожные изменения в виде покраснения лица («приливы») отмечались у 4 больных и не оказывали существенного влияния на самочувствие пациентов. Заключение. Таким образом, силденафил 20 мг продемонстрировал эффективность и безопасность и может быть использован для лечения ЛАГ, ассоциированной с СРЗ.

Timeliness of the topic: Pulmonary arterial hypertension(PAH), associated with systemic rheumaticdiseases(SRD),in particular with diffuse scleroderma, is a progressive disorder characterized by adverse outcomeespecially in lack of adequate treatment. Sildenafil 20 mg relaxes blood vessels and shows antiproliferative effect in patients with SRD.The aim of this paperis to study efficiency and safety of sildenafil in patients with PAH, associated with systemic rheumatic diseases.Material and methods:we have been monitoring the 16-week therapyin 14 patients with PAH, associatedwith systemic scleroderma (12 patients) and systemic lupus erythematosus (2 patients). The efficiency was assessed by the dynamics of clinico-laboratorial indices, central hemodynamics were evaluated using the right heart catheterization before the study and after 16 weeks of treatment.Results:We marked thatthe walkeddistancehad been increased by 31 meterinsix-minute walking testduring the therapy;we also saw the improvement of thefunctional classin 29% of patients.The significant improvement achieved in evaluating the hemodynamic parameters.A significant reduction of mean pulmonary arterial pressure was determined from 50.4 ± 9.2 mm Hg to 40.7 ± 10.2 mm. (p = 0.002), the pulmonary vascular resistance fell from 9.5 ± 5.9 to 6.4 ± 3.7 Wood units(p = 0.05),as well assome of the other indicators decreased.Right atrial pressurefell from8.3 ± 5.5 mm Hg. to 6.5 ± 3.1 mm Hg,we noticedthe stabilizationof left ventricle systolic function indices, thus,cardiac indexin all 14 patients,participatingin our study,had not been undergoingsignificant changes (3.1 ± 0.9 l/min/m2at the beginning of the study and 3.1 ± 0.7 l/min/m 2after 16 weeks of the therapy).The risk level, using scale register REVEAL, significantly decreased frommoderate high (9.0 ± 2.0)to medium (8.2 ± 1.9), (p = 0.04).There were no serious adverse events during the 16-week treatment using sildenafil. Three patients showed predisposition to hypotension, but, the blood pressuredecreased within the normal rangesin total group. Skin changes characterized bydermahemia ("blush") were observed in 4 patients and did not significantly impact on the general well-being of patients.Conclusion: Thus, Sildenafil 20 mgshowedefficiency and safety and could be used in treatment patients with PAH, associated with SRD.

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The authors declare that there are no conflicts of interest present.