Relationship between neutrophil elastase and acute lung injury in humans

医学 临床终点 机械通风 中性粒细胞弹性蛋白酶 重症监护室 内科学 麻醉 临床试验 炎症
作者
S Tamakuma,Michio Ogawa,Naoki Aikawa,Tatsuya Kubota,Hiroyuki Hirasawa,Akitoshi Ishizaka,Nobuyuki Taenaka,Chikuma Hamada,Shozo Matsuoka,Taira Abiru
出处
期刊:Pulmonary Pharmacology & Therapeutics [Elsevier]
卷期号:17 (5): 271-279 被引量:156
标识
DOI:10.1016/j.pupt.2004.05.003
摘要

We conducted clinical trials in patients with acute lung injury (ALI) associated with systemic inflammatory response syndrome using a selective neutrophil elastase inhibitor, sivelestat sodium hydrate (Sivelestat), to investigate the involvement of neutrophil elastase in ALI. In the phase III double-blind study (Study 1) in 230 patients, the efficacy of Sivelestat was evaluated with the pulmonary function improvement (PFI) rating as the primary endpoint, and the weaning rate from mechanical ventilator, the discharge rate from intensive care unit (ICU), and the survival rate as secondary endpoints. Afterwards, an unblinded study (Study 2) in 20 patients was conducted using procedures for weaning from mechanical ventilation to reevaluate its efficacy with ventilator-free days (VFD) value, the primary endpoint, and to compare with that of Study 1 subgroup, which met the selection criteria used in Study 2. Sivelestat increased PFI rating, reduced duration of mechanical ventilation, and shortened stay in ICU in Study 1, although there was no significant efficacy on the survival rate. VFD value in Study 2 was comparable to that in the optimal-dose group of Study 1 subgroup, and increase in VFD value correlated with PFI rating and increase in ICU free days. It was concluded that neutrophil elastase may be involved in the pathogenesis of ALI in humans.
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