Clinical Observation Of Bosentan In Treatment Of Chronic Thromboembolic Pulmonary Hypertension

Objective:This paper analyzed the clinical data of the 16 cases diagnosed as chronic thromboembolic pulmonary hypertension who received bosentan therapy,aiming to summary the clinical efficacy and safety of bosentan in treatment of CTEPH.Methods:Retrospective analysis method was conducted.The object of the study was the CTEPH patients received bosentan treatment in department of respiratory medicine of the First Hospital of Shanxi Medical University from January 2014 to August 2016.16 patients of CTEPH met the inclusion criteria and exclusion criteria.Collected the clinical data of therapeutic evaluation index and safety evaluation index of CTEPH patients before bosentan treatment and after six months treatment and divided into the group before treatment and the group after treatment.The therapeutic evaluation index included6 MWD,Borg dyspnea score,WHO cardiac function classification and NT-proBNP.The arterial blood gas analysis index included PaO2 and PaCO2 and the observation index of echocardiography included PASP,TRV,the right ventricular diameter and the incidence of hydropericardium.The safety evaluation index included liver function and blood cell analysis.Results:After bosentan treatment for 6 months,Patients' exercise capacity was significantly improved.The 6MWD increased to(357.3±104.6)m,significantly longer than beforebosentan treatment(324.8±116.4)m,and Borg dyspnea index decreased from(3.27±1.19)to(2.14±0.73).The comparison all had statistical difference(P<0.05).Compared with pre-treatment,after treatment WHO function classification significantly decreased.The comparison had statistical difference(P<0.05).The level of NT-proBNP after treatment was decreased from(1869.79±793.62)pg/ml to(836.21±294.32)pg/ml,significantly lower than that before treatment.The comparison had statistical difference(P<0.05).The results of arterial blood gas analysis showed that PaO2 significantly improved after treatment,by(53±3.7)mmHg increased to(78±6.3)mmHg.The comparison had statistical difference(P<0.05).PaCO2 before and after treatment respectively(37±6.4)mmHg and(41±2.3)mmHg.The comparison had no statistical difference(P>0.05).After bosentan treatment,PASP decreased to(63.4±22.7)mmHg,significantly lower than before bosentan treatment(80.1±26.3)mmHg.Tricuspid regurgitation velocity was decreased from(4.5±0.69)cm/s to(3.7±0.87)cm/s.The incidence of hydropericardium was decreased from 43.75% to 18.75%.The comparison all had statistical difference(P<0.05).The right ventricular diameter before and after treatment respectively(28±4.7)mm and(25±3.6)mm.The comparison had no statistical difference(P>0.05).One patient had mild transaminase increases and one patient had a slight headache with facial flush during treatment,and no patients discontinued medication because of adverse reaction.Conclusion:Bosentan can significantly improve the exercise tolerance,hypoxemia and WHO heart function classifications in patients with CTEPH;meanwhile significantly decrease the pulmonary artery pressure and improve right ventricular function.The overall tolerability of bosentan treatment was well,and the clinical application was safe.Bosentan is an effective and safe clinical drug in the treatment of CTEPH.