目标:2019年冠状病毒病(COVID-19)是历史上最大的流行病,有严重的并发症,如急性呼吸窘迫综合征和肺动脉高压(PH)。内皮素-1(ET-1)受体拮抗剂,比如波生坦,治疗ET-1水平升高可能是有益的。因此,我们的研究旨在评估波生坦对COVID-19诱导的PH患者的治疗效果。
方法:单中心,随机化,进行了72名参与者的双盲研究;36人接受了波生坦治疗,另外36人接受了安慰剂治疗.肺动脉压,三尖瓣压力梯度,使用超声心动图测量右心房压力。Cox比例风险回归模型用于研究波生坦和患者年龄对6个月随访期间死亡率的影响。
结果:病例组住院死亡率(13%)明显低于对照组(33.3%)(P=0.003)。此外,波生坦改善了超声心动图参数,如肺动脉收缩压和三尖瓣反流梯度(分别为P=0.011和P=0.003)。使用波生坦是600天长期死亡率的重要预测因子[年龄校正风险比为5.24(95%CI1.34至20.46)]。
结论:这项研究为波生坦治疗COVID-19相关PH患者的使用提供了一个混合的观点。Bosentan有效地降低了院内死亡率并改善了超声心动图检查。然而,治疗组的补充氧疗需求和长期死亡率增加.有必要进行更大样本量的进一步研究,以阐明波生坦对COVID-19后PH的影响。
OBJECTIVE: Coronavirus disease 2019 (COVID-19) has been the biggest pandemic in history, with severe complications, such as acute respiratory distress syndrome and pulmonary hypertension (PH). An endothelin-1 (ET-1) receptor antagonist, such as
bosentan, may be beneficial in treating elevated ET-1 levels. Hence, our study aimed to evaluate the therapeutic effects of
bosentan in patients with COVID-19-induced PH.
METHODS: A single-centre, randomized, double-blind study involving 72 participants was carried out; 36 received bosentan and the other 36 received a placebo. Pulmonary arterial pressure, tricuspid valve pressure gradient, and right atrial pressure were measured using echocardiography. The Cox proportional hazards regression model was used to investigate the impact of
bosentan and patients\' age on mortality during a 6-month follow-up period.
RESULTS: In-hospital mortality was significantly lower in the case group (13%) compared with the control group (33.3%) (P=0.003). Additionally, bosentan improved echocardiographic parameters, such as systolic pulmonary artery pressure and tricuspid regurgitation gradient (P=0.011 and P=0.003, respectively).
Bosentan use was a significant predictor of long-term mortality rates for 600 days [age-adjusted hazard ratio of 5.24 (95% CI 1.34 to 20.46)].
CONCLUSIONS: This study provided a mixed perspective on the use of bosentan therapy in patients with COVID-19-related PH.
Bosentan effectively reduced in-hospital mortality and improved echocardiographic measures. However, the treatment group showed an increased requirement for supplemental oxygen therapy and long-term mortality. Further studies with larger sample sizes are necessary to elucidate the effects of bosentan in PH following COVID-19.