Gianetti J, De Caterina M, De Cristofaro T, Ungaro B, Guercio R D, De Caterina R
Laboratory for Thrombosis and Vascular Research, CNR Institute of Clinical Physiology, Pisa, Italy.
Am Heart J. 2001 Oct;142(4):733-9. doi: 10.1067/mhj.2001.118109.
Elevated levels of soluble (s) vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1, pointing to activation of cells involved in vascular inflammation, have been previously reported in peripheral arterial obstructive disease (PAOD). We tested the hypothesis that intravenous prostaglandin E(1) (PGE(1)) treatment, which produces clinical benefits in this condition, might decrease such levels.
Ten subjects (age range 58 +/- 10 years, 6 male, 4 female) with characterized Fontaine stage IIa to IV PAOD (ankle/arm pressure index <0.96) were entered into a treatment protocol with twice daily intravenous infusions of PGE(1) (alprostadil) at 120 microg per day, repeated for 10 consecutive days. Preinfusion and postinfusion plasma samples were stored for blind enzyme immunoassays of soluble adhesion molecules and the fibrinolytic marker tissue plasminogen activator, type-1 plasminogen-activator inhibitor, and D -dimer.
Estimates of severity of pain at rest, consumption of analgesics, magnitude of trophic lesions, remission to lower Fontaine stages, and favorable changes in the venoarteriolar reflex documented significant beneficial effects of the treatment. Significant (P <.01) pretreatment and posttreatment reductions of in all soluble markers explored were found. Particularly, sVCAM-1 exhibited a significant decrease after each infusion, which was sustained at the last day of treatment (from 854 +/- 214 ng/mL to 775 +/- 215 ng/mL across the first infusion, from 773 +/- 146 ng/mL to 680 +/- 110 ng/mL across the last infusion).
Thus a global decrease of vascular cell activation appears to occur as a result of PGE(1) administration and may contribute to the observed clinical benefits in PAOD.
先前报道，外周动脉阻塞性疾病（PAOD）患者的可溶性血管细胞黏附分子-1（sVCAM-1，血管细胞黏附分子-1）和细胞间黏附分子-1水平升高，提示参与血管炎症的细胞被激活。我们检验了如下假说：静脉注射前列腺素E1（PGE1）治疗可降低此类水平，而这种治疗在PAOD中具有临床益处。
10名确诊为Fontaine IIa至IV期PAOD（踝/臂压力指数<0.96）的受试者（年龄范围58±10岁，男性6名，女性4名）进入治疗方案，每天两次静脉输注PGE1（前列地尔），剂量为每天120μg，连续重复10天。输注前和输注后的血浆样本储存起来，用于对可溶性黏附分子以及纤溶标志物组织型纤溶酶原激活物、1型纤溶酶原激活物抑制剂和D-二聚体进行盲法酶免疫测定。
静息痛严重程度、镇痛药使用量、营养性损害程度、Fontaine分期降低、静脉小动脉反射的有利变化等评估结果均表明该治疗具有显著的有益效果。在所有检测的可溶性标志物中，治疗前和治疗后均有显著降低（P<0.01）。特别是，每次输注后sVCAM-1均显著下降，并在治疗的最后一天保持下降状态（首次输注时从854±214 ng/mL降至775±215 ng/mL，最后一次输注时从773±146 ng/mL降至680±110 ng/mL）。
因此，给予PGE1似乎会导致血管细胞激活的整体下降，并可能有助于PAOD中观察到的临床益处。
