Pérez-Peñate Gregorio Miguel, Juliá-Serdà Gabriel, Ojeda-Betancort Nazario, García-Quintana Antonio, Pulido-Duque Juan, Rodríguez-Pérez Aurelio, Cabrera-Navarro Pedro, Gómez-Sánchez Miguel Angel
Pneumology Unit, Hospital General de Gran Canaria Dr Negrín, Gran Canaria, Spain.
J Heart Lung Transplant. 2008 Dec;27(12):1326-32. doi: 10.1016/j.healun.2008.08.007. Epub 2008 Oct 26.
Inhaled nitric oxide (iNO) is a potent pulmonary vasodilator, but therapeutic experience in patients with severe pulmonary hypertension is scarce.
Eleven patients with severe pulmonary hypertension, 6 due to pulmonary arterial hypertension and 4 due to chronic thromboembolic disease, were selected for iNO therapy. A phosphodiesterase type 5 inhibitor (PDE5i) was added in cases of clinical worsening. In this study we evaluate the clinical effectiveness and safety of long-term treatment with iNO either alone or combined with a PDE5i.
After 1 month of iNO administration, improvements were observed in World Health Organization functional class, Borg scale (p = 0.003), brain natriuretic peptide levels (p = 0.002) and 6-minute walk test (p = 0.003). After 6 months of treatment, 7 patients had clinical deterioration that was reversed upon adding a PDE5i. One of these patients died in Month 8 and another underwent pulmonary transplantation in Month 9. The clinical condition of the remaining 9 patients was unchanged after 1 year. A second right catheterization showed improvement in mean pulmonary arterial pressure (66 +/- 15 mm Hg to 56 +/- 18 mm Hg; p = 0.01), pulmonary vascular resistance (1,234 +/- 380 dyn/s/cm(5) to 911 +/- 410 dyn/s/cm(5); p = 0.008) and cardiac index (2.0 +/- 0.4 liters/min/m(2) to 2.5 +/- 0.4 liters/min/m(2); p = 0.04). There was no significant increase in methemoglobin, no worsening of pulmonary function and no sudden withdrawal syndrome.
We suggest that iNO therapy alone or in combination with a PDE5i could be a therapeutic alternative for severe pulmonary hypertension.
吸入一氧化氮（iNO）是一种强效的肺血管扩张剂，但在重度肺动脉高压患者中的治疗经验较少。
选择11例重度肺动脉高压患者，其中6例因肺动脉高压，4例因慢性血栓栓塞性疾病接受iNO治疗。临床病情恶化时加用5型磷酸二酯酶抑制剂（PDE5i）。在本研究中，我们评估单独使用iNO或联合PDE5i进行长期治疗的临床有效性和安全性。
iNO给药1个月后，世界卫生组织功能分级、博格量表（p = 0.003）、脑钠肽水平（p = 0.002）和6分钟步行试验（p = 0.003）均有改善。治疗6个月后，7例患者出现临床恶化，加用PDE5i后病情逆转。其中1例患者在第8个月死亡，另1例在第9个月接受了肺移植。其余9例患者1年后临床状况未改变。第二次右心导管检查显示平均肺动脉压有所改善（从66±15 mmHg降至56±18 mmHg；p = 0.01），肺血管阻力（从1234±380 dyn/s/cm⁵降至911±410 dyn/s/cm⁵；p = 0.008）和心脏指数（从2.0±0.4升/分钟/平方米升至2.5±0.4升/分钟/平方米；p = 0.04）。高铁血红蛋白无显著增加，肺功能无恶化，也无突然撤药综合征。
我们认为单独使用iNO或联合PDE5i治疗可能是重度肺动脉高压的一种治疗选择。
