Short-term oval administration of L-arginine improves hemodynamics and exercise capacity in patients with precapillary pulmonary hypertension
Short-term oval administration of L-arginine improves hemodynamics and exercise capacity in patients with precapillary pulmonary hypertension
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DOI：
10.1164/ajrccm.163.4.2007116
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发表时间：
2001-03-01
影响因子：
24.7
通讯作者：
Miyatake, K
中科院分区：
文献类型：
--
作者：
Nagaya, N;Uematsu, M;Miyatake, K
我们试图评估口服补充L-精氨酸（一氧化氮（NO）的前体）对肺动脉高压患者血流动力学和运动能力的影响。在19例原发性或毛细血管前继发性肺动脉高压患者中检查了口服I-精氨酸（0.5 g/10 kg体重）或安慰剂的急性血流动力学反应。在用L-精氨酸（1.5 g/10 kg体重/d）或安慰剂治疗前和治疗后1周进行心脏运动试验，以测量峰值氧消耗（峰值（V）对点O-2）和对二氧化碳产生的解释反应（（V）对点E（V）对点CO2斜率）。口服补充L-精氨酸显著增加血浆L-瓜氨酸，这表明NO的产生增强。补充L-精氨酸使平均肺动脉压降低9%（53 +/- 4至48 +/- 4 mm Hg，p < 0.05），肺血管阻力降低16%（14.8 ± 1.5至12.4 +/- 1.4 Wood单位，p < 0.05）。L-精氨酸适度降低平均全身动脉压（92 4至87 +/- 3 mm Hg，p < 0.05）。补充L-精氨酸1周后，V峰相对于点o（2）的速度略有增加（831 88至896 +/- 92 ml/min，p < 0.05），（V）相对于点E-（V）相对于点CO2的斜率显著降低（43 4至37 +/- 3，p < 0.05），但无明显的全身性低血压。在安慰剂给药期间，血流动力学和运动能力保持不变。这些结果表明，口服补充L-精氨酸可能对毛细血管前肺动脉高压患者的血流动力学和运动能力有有益的影响。
We sought to assess the effects of oral supplementation of L-arginine, the precursor of nitric oxide (NO), on hemodynamics and exercise capacity in patients with pulmonary hypertension. Acute hemodynamic responses to oral I-arginine (0.5 g/10 kg body weight) or placebo were examined in 19 patients with primary or precapillary secondary pulmonary hypertension. Cardiopulmonary exercise tests were performed to measure peak oxygen consumption (peak (V) over dot O-2) and the ventilatory response to carbon dioxide production ((V) over dot E (V) over dot CO2 slope) before and 1 wk after treatment with L-arginine (1.5 g/10 kg body weight/d) or placebo. Oral supplementation of L-arginine significantly increased plasma L-citrulline, which indicated enhancement of NO production. Supplemental L-arginine produced a 9% decrease in mean pulmonary arterial pressure (53 +/- 4 to 48 +/- 4 mm Hg, p < 0.05) and a 16% decrease in pulmonary vascular resistance (14.8 1.5 to 12.4 +/- 1.4 Wood units, p < 0.05). L-arginine modestly decreased mean systemic arterial pressure (92 4 to 87 +/- 3 mm Hg, p < 0.05). A 1-wk supplementation of L-arginine resulted in a slight increase in peak V over dot o(2) (831 88 to 896 +/- 92 ml/min, p < 0.05) and a significant decrease in the (V) over dot E- (V) over dot CO2 slope (43 4 to 37 +/- 3, p < 0.05) without significant systemic hypotension. Hemodynamics and exercise capacity remained unchanged during placebo administration. These results suggest that oral supplementation of L-arginine may have beneficial effects on hemodynamics and exercise capacity in patients with precapillary pulmonary hypertension.