Prostanoids用於間歇性跛行

BACKGROUND: Peripheral arterial occlusive disease (PAOD) is a common cause of morbidity in the general population. While numerous studies have established the efficacy of prostanoids in PAOD stages III and IV the question of the role of prostanoids as an alternative or additive treatment in patients suffering from claudicatio intermittens (PAOD II) has not yet been clearly answered. OBJECTIVES: The aim of this review was to evaluate effects of prostanoids in patients with intermittent claudication. SEARCH METHODS: Computerised searches of the Cochrane Peripheral Vascular Diseases Specialized Register (last searched July 2004), The Cochrane Central Register of Controlled Trials (CENTRAL) (last searched The Cochrane Library Issue 2, 2004), MEDLINE and EMBASE were undertaken. In addition relevant journals were hand-searched. SELECTION CRITERIA: Randomized clinical trials describing the effects of prostanoids in the treatment of patients suffering from intermittent claudication have been considered for inclusion. DATA COLLECTION AND ANALYSIS: All reviewers assessed the quality of studies and extracted data unblinded. Statistical analysis including tests for heterogeneity and overall effect were performed by using MetaView of Review Manager 4.2. All numeric values are expressed as mean +/- Standard deviation (SD). MAIN RESULTS: Eighteen studies were included for analysis. A significant heterogeneity between the included studies was detected in most of the subgroup analysis. Five studies compared the effects of prostaglandin E1 (PGE1) versus placebo, and reported in their individual results significant increases in walking distances after the administration of PGE1. The attained increase in walking distances appears to be not merely a short-term effect because several studies reported that walking capacity remained increased even after termination of treatment. On the other hand, oral or intravenous prostacyclin did not increase the walking distances significantly. At least one adverse reaction was reported from 23.6% of the participants treated with prostacyclin (PGI2), and its analogues and from 13.7% of the participants treated with PGE1. AUTHORS' CONCLUSIONS: Because of the heterogeneity between most of the included studies, we did not pool relevant parts of the data by meta-analysis. Based on the individual results of the published literature, patients with intermittent claudication seem to benefit from administration (intravenous or intra-arterial) of PGE1 by a significant improvement of their walking capacity. Further well-conducted randomized, double blinded trials, with a sufficient number of participants to provide statistical powerful information, should be performed to confirm the results of this review.