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href='/xywy/'>寻医·问药</a>><a href='/xywy/mjjt/'>名家健坛</a></span><span id="i2i2jyu4k" class="t" id="a1"><a href="/xywy/mjjt/">名家健坛</a></span></h1> <div id="i2i2jyu4k" class="pa_0_5_0_10"> <h1 class="Content_title" id="hh"> <p style="">小儿心内科专家顾虹：</p> <span id="a" style="">肺动脉高压并非罕见病药费高昂应尽早纳入医保</span> </h1> <script>/*jQuery('#hh').width(jQuery('#a').width());*/</script> <div id="i2i2jyu4k" class="Remark"> <span>2018年01月18日 09:21 | 来源：<a target="_blank">新华网</a></span> <span id="i2i2jyu4k" class="fr"> <div id="i2i2jyu4k" class="bdsharebuttonbox"><a href="#" class="bds_more" data-cmd="more"></a><a href="#" class="bds_qzone" data-cmd="qzone" title="分享到QQ空间"></a><a href="#" class="bds_tsina" data-cmd="tsina" title="分享到新浪微博"></a><a href="#" class="bds_tqq" data-cmd="tqq" title="分享到腾讯微博"></a><a href="#" class="bds_renren" data-cmd="renren" title="分享到人人网"></a><a href="#" class="bds_weixin" data-cmd="weixin" title="分享到微信"></a></div> <script>window._bd_share_config={"common":{"bdSnsKey":{},"bdText":"","bdMini":"2","bdMiniList":false,"bdPic":"","bdStyle":"0","bdSize":"16"},"share":{}};with(document)0[(getElementsByTagName('head')[0]||body).appendChild(createElement('script')).src='http://bdimg.share.baidu.com/static/api/js/share.js?v=89860593.js?cdnversion='+~(-new Date()/36e5)];</script> </span><span id="i2i2jyu4k" class="fr">分享到：<img src="/images/fx.jpg" /> </span> </div> <div id="i2i2jyu4k" class="text_box"> <p align="center"> <p style="text-indent: 2em; text-align: left;">新华网北京1月17日电（王坤朔）1月16日，浙江省人社厅官网发布通知，将28种药品纳入浙江省大病保险支付范围名单，肺动脉高压靶向药物安立生坦位列其中。西藏、宁夏等地的省级医保目录近期也纳入了安立生坦，肺动脉高压药物在患者可及性上又迈出一步。</p><p style="text-indent: 2em; text-align: left;">提到高血压，人们都很熟悉，认为是常见的、非致命的慢性病。但如果肺动脉发生“高血压”，处于高压状态，后果将十分凶险，这就是肺动脉高压。近日，北京安贞医院小儿心脏内科顾虹教授在接受新华网采访时表示，肺动脉高压是由于多种疾病引发的常见病理表现，有“肺血管疾病中的癌症”之称，患者非常痛苦，药费负担重。</p><p style="text-align:center"><img id="{4558F072-A2D2-46B3-A8B3-0256338592FA}" title="" border="0" src="http://www.xinhuanet.com/health/2018-01/17/1122269511_15161490479341n.jpg" width="404" height="478" sourcename="本地文件" sourcedescription="编辑提供的本地文件" style="border-width: 0px; border-style: solid; border-color: rgb(0, 0, 0); vertical-align: middle; margin: 10px 0px; max-width: 100%; height: auto !important;"/></p><p style="text-indent: 2em; text-align: center;">北京安贞医院小儿心脏内科顾虹教授</p><p style="text-indent: 2em; text-align: left;"><strong>肺动脉高压是常见临床综合征，在我国先心病是主要病因之一</strong></p><p style="text-indent: 2em; text-align: left;">人体的循环系统由体循环和肺循环构成，人们平常所熟知的高血压，就是体循环的压力高出正常范围，而肺动脉高压则是肺循环出现了压力增高的病理状态。顾虹解释道，肺动脉比主动脉的血压低很多，一般平均压小于25mmHg，肺循环处于低压低阻状态，右心室肌肉薄，收缩力相对较弱。肺血管一旦发生病变，造成肺动脉的压力阻力突然增高，血液无法正常循环，会造成右心室扩大、肥厚、右心衰竭，患者会出现颈静脉怒张、腹水、心包积液、下肢水肿等症状。罹患肺动脉高压的患者由于缺氧，导致指甲、脸颊、嘴唇呈现不同程度的蓝紫色。由于社会知晓率低，临床上漏诊误诊比率偏高，很多肺动脉高压患者进展为心功能Ⅲ/Ⅳ级时才被确诊，死亡率很高。</p><p style="text-indent: 2em; text-align: left;">多年来，肺动脉高压常以罕见病的定位出现在大众视野。其实，肺动脉高压是一种以肺动脉压力阻力增高为特征的临床综合症，由多种复杂因素引发，是心血管常见疾病。先天性心脏病、左心衰竭、瓣膜病、慢阻肺、风湿免疫系统疾病以及家族遗传等疾病都会引发肺动脉高压，只有其中的特发性肺动脉高压（发病原因不明）属于罕见病，参考国外数据，特发性肺动脉高压发病率约为2-5例/百万人/年。</p><p style="text-indent: 2em; text-align: left;">“发病原因复杂是造成肺动脉高压治疗困难的原因之一。同时，对肺动脉高压的知晓率低、全国整体诊疗水平不高，让防控形势更为严峻?！惫撕绫硎?，从我国一些大型心脏中心的临床实际来看，先天性心脏病是我国导致肺动脉高压的最主要原因，约有一半左右由先心病造成。值得注意的是，先心病是目前我国新生儿出生缺陷之首。</p><p style="text-indent: 2em; text-align: left;">“如果先心病患儿在1岁内接受手术，可有效扼制今后发生肺动脉高压，孩子也能像正常人一样成长、生活。但目前先心病手术缺口很大，有大量患者未能及时接受手术治疗，有很大一部分将来会成为肺动脉高压的高危人群?！惫撕缫韵刃牟∥得髁四壳拔夜味龈哐沟难暇肿础?/p><p style="text-indent: 2em; text-align: left;">虽然近十年来我国肺动脉高压的诊疗水平有明显提升，但从全国范围来看，整体诊疗能力亟待加强。尤其是基层医生，对肺动脉高压认识不足，诊断不明确、用药不规范?！叭没阋皆汉突阋缴芯氛锒稀⒅瘟品味龈哐沟哪芰ο匀徊幌质?，但应该加强医务人员的认识，让他们能识别疾病，向上推荐到有接诊能力的医疗机构。”顾虹说。</p><p style="text-indent: 2em; text-align: left;">据了解，在北京地区，安贞医院、阜外医院、协和医院、中日友好医院、朝阳医院、北京医院等六家医院组成了肺动脉高压会诊平台，经常针对病例举行多学科会诊，各医院、专家贡献自己的学科专长。同时，这六家医院还发起了肺动脉高压学院，组织培训全国各地的骨干医生，以期加强肺动脉高压的整体诊疗水平。</p><p style="text-indent: 2em; text-align: left;"><strong>高药价患者治疗难以为继，呼吁早日纳入医保</strong></p><p style="text-indent: 2em; text-align: left;">尽管肺动脉高压恶性化程度很高、治疗复杂，但内皮素受体拮抗剂、磷酸二酯酶抑制剂和前列环素等药物能明显改善患者临床症状，提高生活质量，延长生存期。然而，这些药物价格昂贵，并且不在国家医保范围内，只有个别省市将个别药物纳入地方医保，仍有许多患者处于“有药不治”的境地。</p><p style="text-indent: 2em; text-align: left;">以常见靶向药安立生坦为例，尽管已多次降价，成人患者每个月的药费仍然近4000元。欧洲心血管学会（ESC）发布的2015年欧洲《肺动脉高压诊断与治疗指南》中推荐了多药联合治疗，估算每月药费至少要七八千元，每年花费近10万元，且很多病人需终身服药。</p><p style="text-indent: 2em; text-align: left;">“医生和患者其实处于同一困境中?！痹诓煞弥?，顾虹略显无奈地说，“价格是患者是否选择、以及能否持续规范用药的第一考虑因素，医生在制定治疗方案的时候也需要考虑患者的经济承受能力，不然开出的处方患者也吃不起?！?/p><p style="text-indent: 2em; text-align: left;">因病致贫在肺动脉高压患者家庭十分常见，因无力支付高额药费而被迫放弃治疗的患者也很多。顾虹在采访前刚刚接诊了一名来自山东农村的13岁女孩，在上体育课时突然昏厥，被确诊为肺动脉高压，按照儿童剂量服药每个月需药费三四千元，没有医保报销，而女孩家全年的收入是1万多元。</p><p style="text-indent: 2em; text-align: left;">“除了特发性肺动脉高压外，由其他病因引起的肺动脉高压十分常见，但却没有任何一种药物在国家医保范围内。对于不能手术或病因不能去除的肺动脉高压患者而言，要终身服药，随着病情的进展，可能需要加量或者多药治疗，患者的负?；嵩嚼丛街??！惫撕缛衔?，从目前来看，价格问题是妨碍患者治疗的最主要因素之一，药品企业在调低价格的同时，国家应该进一步发挥医保的作用，实现政府、企业、患者三方共付，降低患者看病负担，提高治疗可及性。</p><p style="text-indent: 2em; text-align: left;">“在肺动脉高压药物进入国家医保目录谈判环节时，应更多地参考相关医学专家的意见，让国家和全社会意识到肺动脉高压的严重性和普遍性。同时，要加强新药研发，让患者有更多治疗机会?！惫撕绫硎尽?/p><p style="text-indent: 2em; text-align: left;">顾虹透露，未来几个月，将陆续有治疗肺动脉高压的新药进入中国，但价格也会非常昂贵?！耙恢忠┪锸欠衲扇胍奖７段?，确实有卫生经济学方面的考量，但决定性的因素应该是患者的需求?；颊呒毙枨野踩行У囊┪?，建议优先纳入医保考虑范围。”顾虹说。</p> </div> <p class="Editor">编辑：赵彦 </p> <div id="i2i2jyu4k" class="Paging"> </div> <p class="Keyword">关键词：肺动脉高压罕见病纳入医保</p> <h1 class="pv_title_2 mt_15"><a href="/index.shtml" target="_blank" class="more mtb_14">更多</a><span id="i2i2jyu4k" class="t" id="a3"><a href="/index.shtml"><img src="/images/xg_t1.jpg" /></a></span></h1> <div id="i2i2jyu4k" class="pa_0_5_0_10"> <ul class="Related_ul bh_150"> <li><a target="_blank" href="/c/2015-05-06/495306.shtml">90%的肺动脉高压患者难以承担高额医疗费</a></li> <li><a target="_blank" href="/c/2018-05-07/2045008.shtml">专家：肺动脉高压应早筛早治、靶向用药、定期随访</a></li> <li><a target="_blank" href="/c/2018-04-18/2028611.shtml">中国颅内动脉瘤计划：大数据平台助力动脉瘤破裂风险研究</a></li> <li><a target="_blank" 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style="opacity:0; z-index:0;"> <a title="詹国枢" target="_blank"> <img src="/upload/resources/image/2014/02/10/172.jpg" class="img" /><ins>詹国枢</ins></a> <a href="ti" title="朱永新" target="_blank"> <img src="/upload/resources/image/2014/02/10/69.jpg" class="img" /><ins>朱永新</ins></a> <a title="张晓梅" target="_blank"> <img src="/upload/resources/image/2014/02/10/171.jpg" class="img" /><ins>张晓梅</ins></a> <a title="焦加良" target="_blank"> <img src="/upload/resources/image/2014/02/10/169.jpg" class="img" /><ins>焦加良</ins></a> <a title="张连起" target="_blank"> <img src="/upload/resources/image/2014/02/10/167.jpg" class="img" /><ins>张连起</ins></a> <a title="龙墨" target="_blank"> <img src="/upload/resources/image/2014/02/10/129.jpg" class="img" /><ins>龙墨</ins></a> <a title="王名" target="_blank"> <img src="/upload/resources/image/2014/02/10/88.jpg" class="img" /><ins>王名</ins></a> <a title="何水法" target="_blank"> <img src="/upload/resources/image/2014/02/10/168.jpg" class="img" /><ins>何水法</ins></a> <a title="李延生" target="_blank"> <img src="/upload/resources/image/2014/02/10/166.jpg" class="img" /><ins>李延生</ins></a> </div> <div id="i2i2jyu4k" class="sliderbox" style="opacity:0; z-index:0;"> <a title="巩汉林" target="_blank"> <img src="/upload/resources/image/2014/02/10/70.jpg" class="img" /><ins>巩汉林</ins></a> <a title="李胜素" target="_blank"> <img src="/upload/resources/image/2014/02/10/173.jpg" class="img" /><ins>李胜素</ins></a> <a title="施杰" target="_blank"> <img src="/upload/resources/image/2014/02/10/124.jpg" class="img" /><ins>施杰</ins></a> <a title="王亚非" target="_blank"> <img src="/upload/resources/image/2014/02/10/120.jpg" class="img" /><ins>王亚非</ins></a> <a title="艾克拜尔·米吉提" target="_blank"> <img src="/upload/resources/image/2014/02/10/128.jpg" class="img" /><ins>艾克拜尔·米吉提</ins></a> <a title="姚爱兴" target="_blank"> <img src="/upload/resources/image/2014/02/10/137.jpg" class="img" /><ins>姚爱兴</ins></a> <a title="贾宝兰" target="_blank"> <img src="/upload/resources/image/2014/02/10/174.jpg" class="img" /><ins>贾宝兰</ins></a> <a title="谢卫" target="_blank"> <img src="/upload/resources/image/2014/02/10/170.jpg" class="img" /><ins>谢卫</ins></a> <a title="汤素兰" target="_blank"> <img src="/upload/resources/image/2014/02/10/176.jpg" class="img" /><ins>汤素兰</ins></a> </div> </div> </li> </ul> <ul style="display:none"> <li> <div class="i2i2jyu4k" id="sliderbox4" class="sliderbox_box"> <div id="i2i2jyu4k" class="sliderbox" style="opacity:0; z-index:0;"> <a title="黄信阳" target="_blank"> <img src="/upload/resources/image/2014/02/15/1079.jpg" class="img" /><ins>黄信阳</ins></a> <a title="张其成" target="_blank"> <img src="/upload/resources/image/2014/02/15/1003.jpg" class="img" /><ins>张其成</ins></a> <a title="潘鲁生" target="_blank"> <img src="/upload/resources/image/2014/02/15/912.jpg" class="img" /><ins>潘鲁生</ins></a> <a title="冯丹藜" target="_blank"> <img src="/upload/resources/image/2014/02/15/907.jpg" class="img" /><ins>冯丹藜</ins></a> <a title="艾克拜尔·米吉提" target="_blank"> <img src="/upload/resources/image/2014/02/15/906.jpg" class="img" /><ins>艾克拜尔·米吉提</ins></a> <a title="袁熙坤" target="_blank"> <img src="/upload/resources/image/2014/02/14/903.png" class="img" /><ins>袁熙坤</ins></a> <a title="毛新宇" target="_blank"> <img src="/upload/resources/image/2014/02/14/896.jpg" class="img" /><ins>毛新宇</ins></a> <a title="学诚法师" target="_blank"> <img src="/upload/resources/image/2014/02/14/850.png" class="img" /><ins>学诚法师</ins></a> <a title="宗立成" target="_blank"> <img src="/upload/resources/image/2014/02/13/848.jpg" class="img" /><ins>宗立成</ins></a> </div> <div id="i2i2jyu4k" class="sliderbox" > <a title="梁凤仪" target="_blank"> <img src="/upload/resources/image/2014/02/13/845.jpg" class="img" /><ins>梁凤仪</ins></a> <a title="施杰" target="_blank"> <img src="/upload/resources/image/2014/02/13/842.jpg" class="img" /><ins>施杰</ins></a> <a title="张晓梅" target="_blank"> <img src="/upload/resources/image/2014/02/13/840.jpg" class="img" /><ins>张晓梅</ins></a> </div> <div id="i2i2jyu4k" 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