Bosentan for sarcoidosis-associated pulmonary hypertension, age-adjusted D-dimer levels in pulmonary embolism, and mean arterial blood pressure targets in septic shock.
Bosentan for sarcoidosis-associated pulmonary hypertension, age-adjusted D-dimer levels in pulmonary embolism, and mean arterial blood pressure targets in septic shock.
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波生坦用于治疗结节病相关的肺动脉高压、肺栓塞中年龄调整的 D-二聚体水平以及感染性休克中的平均动脉血压目标。
DOI：
10.1164/rccm.201407-1305rr
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发表时间：
2014
影响因子：
24.7
通讯作者：
Rose,JasonJ
中科院分区：
文献类型：
--
作者：
Alvarez,RogerA;Barbash,IanJ;Rose,JasonJ
肺动脉高压（PH）存在于大量晚期结节病患者中，并与死亡率增加相关。Baughman及其同事（1）进行了一项双盲、随机、安慰剂对照试验，以确定波生坦是否有效治疗结节病相关PH。共有39例结节病和肺动脉（PA）高血压患者以2：1的比例随机接受波生坦或安慰剂治疗。如果患者有严重的运动受限（纽约心脏协会IV级）、严重的气道阻塞或严重的心力衰竭，则将其排除。在治疗前和治疗16周后进行右心导管检查。结果包括平均肺动脉压、6分钟步行距离（6 MWD）、呼吸困难和生活质量的变化，这些变化通过有效的问卷进行评估。在30例具有连续血流动力学数据的患者中，波生坦组的平均肺动脉压降低了4（66.6）mm Hg（P，0.02），安慰剂组增加了1（63.7）mm Hg（P，0.05）。两组的6 MWD、呼吸困难或生活质量评分均无显著变化。本研究的主要局限性在于其强调PA压力。PA压力的变化与临床结局的相关性较差。PH治疗的当代研究通常强调功能结局，例如6 MWD（2）。在本研究中，波生坦组的6 MWD降低（223 6 69.5 m; P.0.05），而安慰剂组增加（17 6 44.1; P.0.05）。虽然没有统计学显著性，但这种差异以及波生坦组更频繁的去饱和，表明波生坦使某些患者的气体交换恶化（3）。在这项研究中，35名患者中有18名在胸片上有纤维化，用力肺活量低于60%，
Pulmonary hypertension (PH) is present in a significant number of patients with advanced sarcoidosis, and is associated with increased mortality. Baughman and colleagues (1) performed a double-blind, randomized, placebo-controlled trial to determine whether bosentan is effective in treating sarcoidosis-associated PH. A total of 39 patients with sarcoidosis and pulmonary artery (PA) hypertension were randomized to receive either bosentan or placebo in a 2: 1 ratio. Patients were excluded if they had severe exercise limitation (New York Heart Association class IV), severe airway obstruction, or significant heart failure. Right heart catheterization was performed before and after 16 weeks of therapy. Outcomes included the changes in mean PA pressure, 6-minute walk distance (6MWD), dyspnea, and quality of life as assessed by validated questionnaires.In the 30 patients with serial hemodynamic data, mean PA pressure decreased by 4 (66.6) mm Hg in the bosentan group (P, 0.02), and increased by 1 (63.7) mm Hg (P. 0.05) in the placebo group. There was no significant change in 6MWD, dyspnea, or quality of life scores in either group. The major limitation of this study is its emphasis on PA pressure. Changes in PA pressure correlate poorly with clinical outcomes. Contemporary studies of PH therapy generally emphasize functional outcomes, such as 6MWD (2). In this study, 6MWD decreased in the bosentan group (223 6 69.5 m; P. 0.05), whereas it increased in the placebo group (17 6 44.1; P. 0.05). Although not statistically significant, this difference, together with more frequent desaturation in the bosentan group, suggests that bosentan worsened gas exchange in some patients (3). In this study, 18 of 35 patients had fibrosis on chest radiograph, a forced vital capacity of less than 60%,