Collinson Deborah J, Donnelly Richard
University of Nottinham Medical School, Derby City General Hospital, Uttoxeter Road, Derby, DE22 3DT, UK.
Expert Rev Cardiovasc Ther. 2004 Jul;2(4):503-9. doi: 10.1586/14779072.2.4.503.
Intermittent claudication is a common, disabling symptom of peripheral arterial disease that limits walking distance and is associated with an increased cardiovascular risk of acute limb- or life-threatening complications. Very few patients with intermittent claudication (<7%) are suitable candidates for surgical revascularization, yet in contrast to the treatment of stable angina, few effective medical therapies (apart from exercise) are available for the symptomatic relief of intermittent claudication. The phosphodiesterase-3 inhibitor, cilostazol (Pletal, Otsuka Pharmaceuticals Ltd), is the first symptom-relieving treatment for intermittent claudication that has been evaluated successfully in large multicenter placebo-controlled, double-blind clinical trials (involving >2000 patients). A meta-analysis of the eight major efficacy studies with cilostazol has shown significant improvements in pain-free and maximum walking distance, and a good overall safety and tolerability profile. Thus, in the UK, USA and Japan, cilostazol administered at 100 mg twice daily is licensed for symptom relief in patients with stable, moderate-to-severe intermittent claudication, as an adjunct to nonpharmacological approaches such as exercise.
间歇性跛行是外周动脉疾病常见的致残性症状，它限制行走距离，并与急性肢体或危及生命并发症的心血管风险增加相关。很少有间歇性跛行患者（<7%）适合接受手术血运重建，然而与稳定型心绞痛的治疗不同，几乎没有有效的药物疗法（除运动外）可用于缓解间歇性跛行的症状。磷酸二酯酶-3抑制剂西洛他唑（培达，大冢制药有限公司）是首个用于间歇性跛行症状缓解的治疗药物，已在大型多中心安慰剂对照双盲临床试验（涉及>2000例患者）中得到成功评估。对八项关于西洛他唑的主要疗效研究的荟萃分析表明，无痛行走距离和最大行走距离有显著改善，且总体安全性和耐受性良好。因此，在英国、美国和日本，每日两次服用100mg西洛他唑被批准用于稳定的中重度间歇性跛行患者的症状缓解，作为运动等非药物方法的辅助治疗。
