Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema -: A randomized trial
Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema -: A randomized trial
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DOI：
10.7326/0003-4819-145-7-200610030-00007
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发表时间：
2006-10-03
影响因子：
39.2
通讯作者：
Mairbaeurl, Heimo
中科院分区：
文献类型：
--
作者：
Maggiorini, Marco;Brunner-La Rocca, Hans-Peter;Mairbaeurl, Heimo
背景资料：高原肺水肿（High-altitude pulmonary edema，HAPE）是由缺氧性肺血管收缩过度、肺内一氧化氮生物利用度降低和肺泡液重吸收受损引起的。目的：探讨地塞米松或他达拉非是否能降低有HAPE病史的成人HAPE和急性高原病（acute mountain sickness，AAAS）的发病率。设计：随机、双盲、安慰剂对照研究于2003年夏季进行。设置：从490 in在24小时内上升，并在4559 in停留2晚。患者：29名既往患有HAPE的成人。干预：预防性他达拉非（10毫克），地塞米松（8毫克），或安慰剂，每天两次在上升和停留在4559米。测量：胸部X线摄影被用来诊断HAPE。露易丝湖评分大于4定义的AMS。通过使用多普勒超声心动图测量了收缩期肺动脉压，并测量了鼻电位作为肺泡钠transport.Results的替代标记，两名接受他达拉非的参与者在到达4559米时发生了严重的AMS，并退出了研究，他们当时没有HAPE。9例接受安慰剂的受试者中有7例发生高原肺水肿，其余8例接受他达拉非的受试者中有1例发生高原肺水肿，但10例接受地塞米松的受试者中无一例发生高原肺水肿（他达拉非vs安慰剂P = 0.007;地塞米松vs安慰剂P < 0.001）。8/9例接受安慰剂的受试者、7/10例接受他达拉非的受试者和3/10例接受地塞米松的受试者发生AMS（他达拉非vs安慰剂P = 1.0;地塞米松vs安慰剂P = 0.020）。在高海拔地区，接受地塞米松治疗的参与者的收缩期肺动脉压增加较少（16 mmHg [95% CI，9 - 23 mmHg]）和他达拉非（13 mm Hg [Cl，6 - 20 mm Hg]）（28 mm Hg [Cl，20 - 36 min Hg]）（他达拉非与安慰剂组P = 0.005;地塞米松与安慰剂组P = 0.012）。鼻电位和白细胞钠转运蛋白信使RNA.Limitations表达的变化组间无统计学显着差异：该研究涉及一个小样本的成人HAPE的历史。结论：地塞米松和他达拉非降低收缩期肺动脉压，并可能减少HAPE的发病率在成人HAPE的历史。地塞米松预防也可能降低这些成人AMS的发病率。
Background: High-altitude pulmonary edema (HAPE) is caused by exaggerated hypoxic pulmonary vasoconstriction associated with decreased bioavailability of nitric oxide in the lungs and by impaired reabsorption of alveolar fluid.Objective: To investigate whether dexamethasone or tadalafil reduces the incidence of HAPE and acute mountain sickness (AAAS) in adults with a history of HAPE.Design: Randomized, double-blind, placebo-controlled study performed in summer 2003.Setting: Ascent from 490 in within 24 hours and stay for 2 nights at 4559 in.Patients: 29 adults with previous HAPE.Intervention: Prophylactic tadalafil (10 mg), dexamethasone (8 mg), or placebo twice daily during ascent and stay at 4559 m.Measurements: Chest radiography was used to diagnose HAPE. A Lake Louise score greater than 4 defined AMS. Systolic pulmonary artery pressure was measured by using Doppler echocardiography, and nasal potentials were measured as a surrogate marker of alveolar sodium transport.Results, Two participants who received tadalafil developed severe AMS on arrival at 4559 m and withdrew from the study; they did not have HAPE at that time. High-altitude pulmonary edema developed in 7 of 9 participants receiving placebo and 1 of the remaining 8 participants receiving tadalafil but in none of the 10 participants receiving dexamethasone (P = 0.007 for tadalafil vs. placebo; P < 0.001 for dexamethasone vs. placebo). Eight of 9 participants receiving placebo, 7 of 10 receiving tadalafil, and 3 of 10 receiving dexamethasone had AMS (P = 1.0 for tadalafil vs. placebo; P = 0.020 for dexamethasone vs. placebo). At high altitude, systolic pulmonary artery pressure increased less in participants receiving dexamethasone (16 mm Hg [95% Cl, 9 to 23 mm Hg]) and tadalafil (13 mm Hg [Cl, 6 to 20 mm Hg]) than in those receiving placebo (28 mm Hg [Cl, 20 to 36 min Hg]) (P = 0.005 for tadalafil vs. placebo; P = 0.012 for dexamethasone vs. placebo). No statistically significant difference between groups was found in change in nasal potentials and expression of leukocyte sodium transport protein messenger RNA.Limitations: The study involved a small sample of adults with a history of HAPE.Conclusions: Both dexamethasone and tadalafil decrease systolic pulmonary artery pressure and may reduce the incidence of HAPE in adults with a history of HAPE. Dexamethasone prophylaxis may also reduce the incidence of AMS in these adults.