波生坦可预防系统性硬化症患者新发溃疡的发生

作者：Riemekasten G，et al.

翻译：金银姬 ，校对：武东

摘要：背景：60%系统性硬化症患者可出现指端溃疡，影响患者的生活质量及发病率。但目前对于授权药物的使用及治疗指南在日常实践中的应用暂不清楚。

方法：本项回顾性研究通过网上调查83名医生，对系统性硬化症相关指端溃疡的当前治疗标准及预防进行研究。此外，分析161名系统性硬化症合并指端溃疡的患者数据，明确疾病过程中治疗指端溃疡的疗效。

结果：为治疗及预防活动性指端溃疡，主要治疗为局部治疗、钙通道阻滞剂、伊洛前列素和内皮素受体拮抗剂。根据病例分析，90%指端溃疡急性期单用或联合波生坦和伊洛前列素治疗。无指端溃疡的患者或此后发生3次或多次急性指端溃疡发作的患者中，仅有50%患者接受预防性治疗。对于新发指端溃疡的预防，57%无指端溃疡的患者接受波生坦单用或联合治疗。预防性治疗的患者使用波生坦缩短32%急性期。此外，急性期及预防期持续波生坦治疗可减少急性期持续时间，延长新发溃疡发病时间至16%。同时，波生坦可稳定新发溃疡的数目。

结论：总的来说，这些数据提示波生坦对无指端溃疡患者及可能存在急性期指端溃疡的患者有预防新发溃疡的效果。目前对于指端溃疡的治疗建议尚不完善。未来，我们需对指端溃疡的治疗加以关注。

附原文：Abstract BACKGROUND: Digital ulcers (DU) affect up to 60?% of patients with systemic sclerosis (SSc) and have a considerable impact on quality of life and morbidity. It is unclear to what extent authorised medicines are used, and if therapy guidelines are implemented in everyday practice.METHOD:This retrospective health care study examined current standards of treatment for therapy and prevention of SSc-associated DU in an online survey with 83 physicians. Additionally, data from 161 case studies of SSc patients with DU were analysed, and the effect of DU treatment on the course of the disease determined.RESULTS:For treatment and prevention of active DU, physicians predominantly indicated topical therapies, calcium channel blockers, iloprost and endothelin receptor antagonists. According to the case studies, 90?% of episodes with acute DU were treated with bosentan and iloprost in mono- or combination therapy. Preventive treatment was only administered during 50?% of episodes without DU, even after three or more phases with active DU. For the prevention of new DU, bosentan was used in mono- or combination therapy in 57?% of episodes without DU. Bosentan therapy during prevention shortened the following acute phase by 32?%. Additionally, continuous treatment with bosentan in acute and prevention phases reduced the duration of the following acute phase and increased the time to onset of new DU by 16?%. Moreover, bosentan stabilised the number of new DU.CONCLUSION:In summary, these data confirm the efficacy of bosentan in preventing new DU when used in DU-free episodes and possibly also in phases of acute DU. Therapy recommendations for the treatment of DU are currently not fully implemented. In the future, even more attention should be paid to DU therapy.

引自：Riemekasten G, Beissert S, Distler JH, et al. Digital ulcers in systemic sclerosis : A retrospective heath service study analysing treatment with bosentan and other vasoactive therapies. Z Rheumatol. 2016 Aug 17. [Epub ahead of print]