Iontophoretic application of prostaglandin E1 for the treatment of peripheral arterial occlusive disease

前列腺素E_1(PGE_1)经动脉或静脉给药已被临床用于治疗外周动脉闭塞症(PAOD)。然而，动脉内注射前列腺素E_1是有创性的。静脉注射前列腺素E_1的效果较差，可能会导致偷窃现象。我们使用离子导入使高浓度的PGE1直接输送到缺血足。我们的体外研究表明，PGE1通过电泳法渗透无毛小鼠皮肤，但不是通过被动转运。对19例动脉硬化闭塞症患者足背静脉注射前列腺素E_1(20 Mg)。根据激光多普勒流量(LDF)水平测量，PGE1组的皮肤血流量增加率明显高于对照组。间歇性跛行患者和严重腿部缺血患者的LDF水平与PGE1增加的百分比相似。离子导入组LDF水平增加的百分比明显高于静脉滴注PGE1组。应用前列腺素E_1离子导入治疗9例缺血性足部溃疡。其中4例治疗成功。治疗成功的4例患者LDF水平增加的百分比明显高于治疗失败的患者。这项初步研究涉及PGE1的经皮给药和离子导入PGE1对微循环的影响。离子导入的PGE1对缺血性溃疡患者是有益的，如果这种治疗可以增加溃疡附近皮肤的血流量。

Prostaglandin E1 (PGE1) administered intra-arterially or intravenously has been used clinically in the treatment of peripheral arterial occlusive disease (PAOD). However, intraarterial infusion of PGE1 into an artery is invasive. Intravenous administration of PGE1 is less efficacious and may cause a steal phenomenon. We used iontophoresis to allow high concentrations of PGE1 to be delivered directly to the ischemic foot. Our in vitro study showed that PGE1 permeated through hairless mouse skin iontophoretically, but not by passive transport. Nineteen patients with Arteriosclerosis Obliterans were given PGE1 (20mg) iontophoretically on the dorsum of the foot. The increase rate in cutaneous blood flow as measured by Laser Doppler Flux (LDF) level was significantly higher in the PGE1 than in the control saline. The percent increase in LDF levels with PGE1 was similar in the patients with intermittent claudication and that in critical leg ischemia patients. The percent increase in LDF level was significantly higher with iontophoresis than with intravenous drip infusion of PGE1. Iontophoretic application of the PGE1 was used for the purpose of the treatment of an ischemic foot ulcer in 9 patients. Of those, 4 patients were treated successfully. The percent increase in LDF level was significantly higher in 4 patients treated successfully than in those with failed treatment. This preliminary study addressed the transdermal delivery of PGE1 and the microcirculatory effect of iontophoretically applied PGE1. Iontophoretically delivered PGE1 was beneficial in patients with ischemic ulcer if this treatment could increase blood flow of the skin close to the ulcer.