期刊報告-賴金蘭 101.11.7

Inhaled Low-Dose Iloprost for Pulmonary Hypertension: A Prospective, Multicenter, Open-Label Study

Yun-Juan Sun; Chang-Ming Xiong; Guang-Liang Shan; Qing Gu;Wei-Jie Zeng; Xian-Ling Lu; Feng Zhu; Zhi-Hong Liu; Xin-Hai Ni;Jian-Guo He,

報 告 者：賴金蘭

指 導 者：鄭瑞駿

報告日期：101.11.7

Background: Inhaled iloprost (average >30 mg/d) has been considered an effective treatment for severe pulmonary hypertension (PH). Further evidence also showed that low-dose iloprost given intravenously was equally effective as high-dose iloprost in the therapy of systemic sclerosis.

Hypothesis: Patients with pulmonary hypertension will benefit from inhalation of low-dose iloprost.

Methods: Sixty-two patients with PH were enrolled and initiated with neubulizedlow-dose iloprost (2.5 mg per inhalation, 6×daily) for 24 weeks in 13 medical centers in China. Efficacy endpoints included changes in 6-minute walk distance (6MWD), World Health Organization functional class (WHO-FC), and hemodynamic parameters.

Results: Fourteen patients (22.6%) prematurely discontinued the study: 8 due to clinical worsening (6 in WHO-FCIII–IV at baseline), 4 because of protocol change, and 2 patients lost during follow-up. In the remaining 48 patients, 6MWD was increased from 356 ± 98 meters to 414 ± 99 meters (P < 0.001) and WHO-FC improved significantly (P = 0.006) after 24-week inhalation therapy. Cardiac output, cardiac index, and mixed venous oxygen saturation improved significantly compared with baseline (n = 34, P < 0.05). Most of the hemodynamic parameters improved significantly in patients in WHO-FC II (P < 0.05) but not in patients in WHO-FCIII–IV.

Conclusions: Low-dose iloprost inhalation significantly improved exercise capacity and functional status in patients with PH. It was well tolerated. The improvement of hemodynamics was confirmed in patients withWHO-FCI–II but not in patients with WHO-FCIII–IV, suggesting the importance of early treatment in patients with advanced disease stages.