Valerio Giuseppe, Bracciale Pierluigi, Grazia D'Agostino Anna
Ospedale "Ninetto Melli", Divisione di Pneumologia, 2P Via Lecce 246, San Pietro V.co (Brindisi), Italy 72027.
Ther Adv Respir Dis. 2009 Feb;3(1):15-21. doi: 10.1177/1753465808103499.
Pulmonary hypertension (PH) in chronic obstructive pulmonary disease [COPD] is mainly determined by hypoxemia under respiratory failure by means of the functional hypoxemic vasoconstrictor response. Organic changes of vessels, pulmonary vascular remodelling, is gaining increasing relevance. An imbalance of endothelial products takes place with overload of vasoconstrictors and thrombogenic autacoids over vasodilators and anticoagulant factors. Among vasoconstrictors, endothelin is claimed to be an important factor. Our aim is to assess the effect of the anti-endothelin drug Bosentan on pulmonary hemodynamics and lung function in patients affected by COPD and PH.
Bosentan was administered to 16 patients for a period of 18 months, while another 16 patients with overlapping features was used as a control group. Pulmonary function test, hemodynamics, effort performance, dyspnoea ratings and quality of life were recorded at the beginning and after 18 months under stable state.
Bosentan treatment resulted in a significant improvement of PH from 37 + 5 to 31 + 6mm Hg and pulmonary vascular resistance from 442 + 192 to 392 + 180dynes cm(2) and 6MWD from 256 + 118 to 321 + 122m and BODE index from 6.6 + 2.8 to 5.5 + 3U. The effect was most striking in the 30% of patients in GOLD stage III and IV. Most patients in stage IV did not improve, but in all patients the treatment stopped the progressive worsening of hemodynamics over time. The study also highlights the need to identify patients with high pulmonary arterial pressure contrasting with moderate respiratory disease stages, in whom the predominant problem is evidently vascular disease.
This preliminary report suggests that the use of Bosentan in the treatment of PH in COPD is beneficial.
慢性阻塞性肺疾病（COPD）中的肺动脉高压（PH）主要由呼吸衰竭时的低氧血症通过功能性低氧性血管收缩反应所决定。血管的器质性改变，即肺血管重塑，正变得越来越重要。内皮产物出现失衡，血管收缩剂和促血栓形成的自身活性物质超过血管扩张剂和抗凝因子。在血管收缩剂中，内皮素被认为是一个重要因素。我们的目的是评估抗内皮素药物波生坦对COPD合并PH患者肺血流动力学和肺功能的影响。
对16例患者给予波生坦治疗18个月，同时将另外16例具有重叠特征的患者作为对照组。在稳定状态下，于开始治疗时及18个月后记录肺功能测试、血流动力学、运动耐力、呼吸困难分级和生活质量。
波生坦治疗使PH从37 + 5显著改善至31 + 6mmHg，肺血管阻力从442 + 192降至392 + 180达因·厘米²，6分钟步行距离从256 + 118米增至321 + 122米，BODE指数从6.6 + 2.8降至5.5 + 3U。在全球慢性阻塞性肺疾病倡议（GOLD）III期和IV期的30%患者中效果最为显著。IV期的大多数患者没有改善，但在所有患者中，治疗阻止了血流动力学随时间的进行性恶化。该研究还强调需要识别肺动脉压高但呼吸系统疾病阶段为中度的患者，在这些患者中，主要问题显然是血管疾病。
这份初步报告表明，使用波生坦治疗COPD中的PH是有益的。
