Nagaya Noritoshi, Kyotani Shingo, Uematsu Masaaki, Ueno Kazuyuki, Oya Hideo, Nakanishi Norifumi, Shirai Mikiyasu, Mori Hidezo, Miyatake Kunio, Kangawa Kenji
Department of Internal Medicine, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan.
Circulation. 2004 Jan 27;109(3):351-6. doi: 10.1161/01.CIR.0000109493.05849.14. Epub 2004 Jan 12.
Adrenomedullin (AM) is a potent pulmonary vasodilator peptide. However, whether intratracheal delivery of aerosolized AM has beneficial effects in patients with idiopathic pulmonary arterial hypertension remains unknown. Accordingly, we investigated the effects of AM inhalation on pulmonary hemodynamics and exercise capacity in patients with idiopathic pulmonary arterial hypertension.
Acute hemodynamic responses to inhalation of aerosolized AM (10 microg/kg body wt) were examined in 11 patients with idiopathic pulmonary arterial hypertension during cardiac catheterization. Cardiopulmonary exercise testing was performed immediately after inhalation of aerosolized AM or placebo. The work rate was increased by 15 W/min until the symptom-limited maximum, with breath-by-breath gas analysis. Inhalation of AM produced a 13% decrease in mean pulmonary arterial pressure (54+/-3 to 47+/-3 mm Hg, P<0.05) and a 22% decrease in pulmonary vascular resistance (12.6+/-1.5 to 9.8+/-1.3 Wood units, P<0.05). However, neither systemic arterial pressure nor heart rate was altered. Inhalation of AM significantly increased peak oxygen consumption during exercise (peak o(2), 14.6+/-0.6 to 15.7+/-0.6 mL. kg(-1). min(-1), P<0.05) and the ratio of change in oxygen uptake to that in work rate (Deltao(2)/DeltaW ratio, 6.3+/-0.4 to 7.0+/-0.5 mL. min(-1). W(-1), P<0.05). These parameters remained unchanged during placebo inhalation.
Inhalation of AM may have beneficial effects on pulmonary hemodynamics and exercise capacity in patients with idiopathic pulmonary arterial hypertension.
肾上腺髓质素（AM）是一种强效的肺血管舒张肽。然而，雾化AM经气管给药对特发性肺动脉高压患者是否具有有益作用仍不清楚。因此，我们研究了吸入AM对特发性肺动脉高压患者肺血流动力学和运动能力的影响。
在11例特发性肺动脉高压患者进行心导管检查时，检测了雾化AM（10微克/千克体重）吸入后的急性血流动力学反应。在雾化AM或安慰剂吸入后立即进行心肺运动试验。通过逐次呼吸气体分析，工作负荷以每分钟15瓦的速度增加，直至达到症状限制的最大值。吸入AM使平均肺动脉压降低了13%（从54±3降至47±3毫米汞柱，P<0.05），肺血管阻力降低了22%（从12.6±1.5降至9.8±1.3伍德单位，P<0.05）。然而，体循环动脉压和心率均未改变。吸入AM显著增加了运动期间的峰值耗氧量（峰值O₂，从14.6±0.6增至15.7±0.6毫升·千克⁻¹·分钟⁻¹，P<0.05）以及摄氧量变化与工作负荷变化的比值（ΔO₂/ΔW比值，从6.3±0.4增至7.0±0.5毫升·分钟⁻¹·瓦⁻¹，P<0.05）。在吸入安慰剂期间，这些参数保持不变。
吸入AM可能对特发性肺动脉高压患者的肺血流动力学和运动能力具有有益作用。
