Pilot study of pentoxifylline in hepatopulmonary syndrome.
Pilot study of pentoxifylline in hepatopulmonary syndrome.
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DOI：
10.1002/lt.21482
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发表时间：
2008-08
影响因子：
4.6
通讯作者：
Fallon, Michael B.
中科院分区：
文献类型：
--
作者：
Tanikella, Rajasekhar;Philips, George M.;Faulk, Dorothy K.;Kawut, Steven M.;Fallon, Michael B.
肝肺综合征（HPS）是慢性肝病或门静脉高压引起肺内微血管扩张伴低氧血症的结果。在实验性HPS中，肿瘤坏死因子α (TNF-α)的过量产生有助于血管舒张，而TNF-α抑制剂己酮茶碱可改善血管舒张。己酮茶碱对人体的有效性尚不清楚。这项开放标签、单臂临床试验的目的是评估己酮茶碱在肝硬化和晚期HPS患者接受肝移植评估中的疗效和耐受性。9名成人肝硬化和中度至重度HPS患者入组。所有患者最初2周滴药至目标剂量己酮茶碱400mg，每8小时口服一次，持续6周。评估基线和随访动脉血气和TNF-α水平。评估了不良反应和耐受性。9例患者平均年龄55±10岁，其中67%为女性。肝硬化最常见的原因是丙型肝炎病毒和酒精（55%）。终末期肝病模型平均评分为11（范围6-19），患者为晚期低氧血症[平均动脉氧分压(PaO2) = 54±12 mm Hg，平均肺泡-动脉氧梯度(a - PaO2) = 57±15 mm Hg]。在纳入的9名患者中，有7名患者进行了随访血气检测。治疗前后PaO2 （P = 0.3）和a - PaO2 （P = 0.3）无显著变化。己酮茶碱耐受性差。恶心（100%）和呕吐（56%）是主要的副作用，只有一名患者能够完成全剂量治疗。己酮茶碱治疗并没有改善晚期HPS患者的动脉氧合，而且耐受性受到胃肠道毒性的限制。
Hepatopulmonary syndrome (HPS) results when chronic liver disease or portal hypertension causes intrapulmonary microvascular dilatation with hypoxemia. In experimental HPS, tumor necrosis factor alpha (TNF-α) overproduction contributes to vasodilatation, which is improved by pentoxifylline, a TNF-α inhibitor. The effectiveness of pentoxifylline in humans is unknown. The aim of this open-label, single-arm clinical trial was to assess the efficacy and tolerability of pentoxifylline in patients with cirrhosis and advanced HPS undergoing liver transplantation evaluation. Nine adults with cirrhosis and moderate to severe HPS were enrolled. All patients had an initial 2-week titration to a target dose of pentoxifylline of 400 mg by mouth every 8 hours, which was continued for 6 weeks. Baseline and follow-up arterial blood gases and TNF-α levels were evaluated. Adverse effects and tolerability were assessed. The 9 patients had a mean age of 55 ± 10 years, and 67% were female. The most common causes of cirrhosis were hepatitis C virus and alcohol (55%). The mean Model for End-Stage Liver Disease score was 11 (range, 6-19), and patients had advanced hypoxemia [mean partial pressure of arterial oxygen (PaO2) = 54 ± 12 mm Hg, mean alveolar-arterial oxygen gradient (A-a PaO2) = 57 ± 15 mm Hg]. Of the 9 patients enrolled, follow-up blood gases were done in 7. There was no significant change in PaO2 (P = 0.3) or A-a PaO2 (P = 0.3) with treatment. Pentoxifylline was poorly tolerated. Nausea (100%) and vomiting (56%) were the predominant side effects, and only a single patient was able to complete full-dose therapy. Treatment with pentoxifylline did not improve arterial oxygenation in advanced HPS, and tolerance was limited by gastrointestinal toxicity.
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影响因子：
29.4
作者：
Fallon, MB;Abrams, GA;Ku, DD
通讯作者：
Ku, DD
DOI：
10.1164/rccm.200201-027oc
发表时间：
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