ACCP8指南解读.ppt

* 西洛他唑同样可抑制磷酸二酯酶的活性，增加腺苷环化酶的活性，从而抑制血小板聚集。对于外周动脉疾病间歇性跛行患者，西洛他唑具有明显的疗效。 OBJECTIVES: To assess whether cilostazol, a phosphodiesterase III inhibitor, improves treadmill and communitybased walking ability and health-related quality of life(HQL) in patients with intermittent claudication resulting from peripheral arterial disease (PAD). DESIGN: Retrospective meta-analysis of data pooled from six Phase 3, multicenter, double-blind, placebo-controlled, parallel-group, randomized studies. SETTING: Patients were recruited from outpatient ambulatory medical care facilities. PARTICIPANTS: Patients’ (n1,751) mean age standard deviation was 659, and they had a history of PAD for 6 months or longer and an ankle brachial index (ABI)of 0.90 or less. INTERVENTION: Cilostazol 50 mg bid or 100 mg bid for 12, 16, or 24 weeks. MEASUREMENTS: ABI; maximal walking distance (MWD); pain-free walking distance on a graded and constant- load treadmill; and HQL, measured using the Walking Impairment Questionnaire (WIQ) and the Medical Outcomes Study Short Form-36 (SF-36). RESULTS: Maximal treadmill walking distance improved more in both cilostazol groups than in the placebo group (both P.0001). WIQ and SF-36 physical summary scores improved significantly more with cilostazol than with placebo (for instance, WIQ distance score, P.0001 and SF-36 physical summary score, P.0001, comparing persons taking cilostazol with controls). Improved MWD correlated with improvements in WIQ (correlation with distance score, r0.34, P.0001) and SF-36 physical summary scores (r0.29,P.0001). CONCLUSIONS: Treatment with cilostazol was associated with greater improvements in community-based walking ability and HQL in patients with intermittent claudication than treatment with placebo. These improvements correlatedwith increased MWD. This analysis of effects of cilostazol on improving walking ability in persons with claudication is the first cilostazol study focused on community-based measures of functional status and