一种新的选择性前列环素IP受体激动剂selexipag在特发性肺动脉高压患者中的成功应用的病例报告

Z. Valieva, T. Martynyuk
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摘要

特发性肺动脉高压(Idiopathic pulmonary arterial hypertension, IPAH)是一种非常罕见的心血管疾病,原因不明,同时也是肺动脉高压(pulmonary arterial hypertension, PAH)最常见的形式。其特征是平均肺动脉压升高≥25 mm Hg,肺血管阻力升高> 3 Wood单位。IPH发病机制的关键组成部分之一是前列环素通路紊乱,导致平滑肌和内皮细胞肥大、纤维化改变、炎症反应和血管收缩,导致小动脉和小动脉重塑。对于严重的PAH病例,在俄罗斯只使用一种作用于前列环素途径的药物,即吸入伊洛前列素。然而,这种疗法在使用上有一些限制。Selexipag是第一个用于治疗PAH患者的选择性口服前列环素ip受体激动剂。GRIPHON研究是迄今为止在肺动脉高压患者中进行的最大规模的临床试验,旨在研究Selexipag对PAH患者的疗效和安全性。该出版物提出了一个成功使用Selexipag作为IPAH患者联合治疗的一部分的案例。
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CASE REPORT ON THE SUCCESSFUL USE OF A NEW SELECTIVE PROSTACYCLIN IP RECEPTOR AGONIST, SELEXIPAG, IN A PATIENT WITH IDIOPATHIC PULMONARY HYPERTENSION
Idiopathic pulmonary arterial hypertension (IPAH) is a rather rare cardiovascular disease of unknown origin and, at the same time, the most common form of pulmonary arterial hypertension (PAH). It is characterized by increased mean pulmonary artery pressure of ≥ 25 mm Hg and increased pulmonary vascular resistance of > 3 Wood units. One of the key components of IPH pathogenesis is the disorder in the prostacyclin pathway leading to hypertrophy of the smooth muscle and endothelial cells, fibrotic changes, inflammatory response and vasoconstriction, which results in small artery and arteriole remodeling. For severe cases of PAH, in Russia only used one drug acting on the prostacyclin pathway, i.e., iloprost for inhalation. However, this therapy has a number of restrictions on the use. Selexipag is the first selective oral prostacyclin IP-receptor agonist intended for the treatment of patients with PAH. The efficacy and safety of Selexipag in patients with PAH were investigated in GRIPHON study, the largest-scale clinical trial ever conducted in patients with pulmonary hypertension. The publication presents a case of successful use of Selexipag as a part of the combination therapy in a patient with IPAH.
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