Low occurrence of digital ulcers in scleroderma patients treated with bosentan for pulmonary arterial hypertension: a retrospective case-control study
Low occurrence of digital ulcers in scleroderma patients treated with bosentan for pulmonary arterial hypertension: a retrospective case-control study
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DOI：
10.1007/s10067-013-2172-z
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发表时间：
2013-05-01
影响因子：
3.4
通讯作者：
Punzi, L.
中科院分区：
文献类型：
--
作者：
Cozzi, F.;Pigatto, E.;Punzi, L.
指端溃疡（DU）是系统性硬化症（SSc）中最常见的血管病变表现之一。为了改善患者的治疗结果，预防这些疾病是重要的，因为它们对社会产生经济影响。随机对照研究表明，波生坦，内皮素受体拮抗剂，减少新的DU的出现。这项回顾性研究的目的是评估DU的发生率在一组患者接受长期波生坦治疗肺动脉高压相关的SSc（PAH-SSc）。对接受波生坦治疗至少6个月的PAH-SSc患者（n = 30）进行了评价。30例未接受波生坦治疗但性别、年龄、病程和皮肤型SSc匹配的SSc患者被视为对照组。在波生坦给药组和未给药组中确定DU（定义为表皮、真皮和皮下组织中不同程度的组织损失）的发生率。波生坦治疗的平均持续时间为3.6年。波生坦治疗组6例患者（20.0%）和未治疗组16例患者（53.3%）检测到DU（p = 0.0015）。在研究结束时，有或无DU的患者之间的人口统计学或临床特征无显著差异。接受长期波生坦治疗的PAH-SSc患者的DU发生率显著低于未经治疗的患者。这项长期观察性研究的结果为PAH-SSc患者的管理提供了有价值的信息。
Digital ulcers (DU) are one of the most common and debilitating manifestations of vasculopathy in systemic sclerosis (SSc). Their prevention is important in order to improve patients' outcome and as a result of the economic impact they have on society. Randomised controlled studies have demonstrated that bosentan, an endothelin receptor antagonist, reduces the appearance of new DU. The aim of this retrospective study was to evaluate the occurrence of DU in a group of patients receiving long-term bosentan treatment for pulmonary arterial hypertension associated with SSc (PAH-SSc). Patients with PAH-SSc and treated with bosentan for at least 6 months (n = 30) were evaluated. Thirty patients with SSc not treated with bosentan, but matched for sex, age, disease duration and cutaneous form of SSc, were considered as a control group. The occurrence of DU, defined as loss of tissue of varying degrees in the epidermis, dermis and subcutaneous tissue, was determined in the bosentan-treated and untreated groups. Mean duration of bosentan treatment was 3.6 years. DU were detected in six patients in the bosentan-treated group (20.0 %) and 16 patients (53.3 %) in the untreated group (p = 0.0015). There were no significant differences in demographic or clinical characteristics between patients with or without DU at study end. The occurrence of DU in patients with PAH-SSc receiving long-term bosentan treatment was significantly lower than in untreated patients. The results from this long-term observational study provide valuable information on management of patients with PAH-SSc.