Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA.
Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA.
Pulm Circ. 2015 Mar;5(1):198-203. doi: 10.1086/679725.
Iloprost, an inhaled synthetic prostacyclin analogue, improves hemodynamic and clinical status with minimal systemic adversity in patients with pulmonary arterial hypertension. Our single-site, prospective case series aimed to determine the effects of iloprost in subjects with group 2 pulmonary hypertension and heart failure with preserved ejection fraction. Patients referred to Boston Medical Center for initial evaluation of suspected pulmonary hypertension received a test dose of 2.5 μg inhaled iloprost, followed by two subsequent doses of 5 μg. Hemodynamic measurements were recorded for each inhalation after 15, 30, 60, and 90 minutes. Results were analyzed via paired t test and signed-rank test. Eight subjects fulfilled criteria and elected to enter the study. There was a reduction of pulmonary arterial pressure (by an average of 7.0 mmHg [P = 0.005] and 4.7 mmHg [P = 0.021] with the first and second 5-μg inhalations, respectively) and pulmonary vascular resistance (by an average of 161.9 dyn·s/cm(5) [P = 0.019] and 95.0 dyn·s/cm(5) [P = 0.014] with the first and second 5-μg inhalations, respectively). There were trends for increased cardiac output and decreased oxygen saturation. There were no changes in other vital or hemodynamic parameters, including pulmonary capillary wedge pressure. All patients completed each cycle of iloprost administration without preestablished termination criteria. In patients with pulmonary hypertension and heart failure with preserved ejection fraction, inhaled iloprost resulted in acute reduction of pulmonary arterial pressure and pulmonary vascular resistance. Further evaluation of iloprost in this subset of patients is warranted.
依前列醇，一种吸入性合成前列环素类似物，可改善肺动脉高压患者的血液动力学和临床状况，同时对全身影响最小。我们的单中心前瞻性病例系列旨在确定依前列醇在 2 型肺动脉高压和射血分数保留性心力衰竭患者中的作用。因疑似肺动脉高压而到波士顿医疗中心接受初步评估的患者接受了 2.5μg 吸入依前列醇的测试剂量，随后给予了两次 5μg 的剂量。每次吸入后 15、30、60 和 90 分钟记录血液动力学测量值。通过配对 t 检验和符号秩检验分析结果。8 名符合标准并选择进入研究的患者。肺动脉压降低（第一次和第二次吸入 5μg 后分别平均降低 7.0mmHg [P=0.005]和 4.7mmHg [P=0.021]），肺血管阻力降低（第一次和第二次吸入 5μg 后分别平均降低 161.9dyn·s/cm(5) [P=0.019]和 95.0dyn·s/cm(5) [P=0.014]）。心输出量增加和氧饱和度降低的趋势。其他重要或血液动力学参数（包括肺毛细血管楔压）无变化。所有患者均完成了每个依前列醇给药周期，而没有预先设定的终止标准。在肺动脉高压和射血分数保留性心力衰竭患者中，吸入依前列醇可导致肺动脉压和肺血管阻力急性降低。进一步评估依前列醇在这组患者中的作用是必要的。
