Petrosillo N, Pellicelli A M, Boumis E, Ippolito G
Istituto Nazionale per le Malattie Infettive, L. Spallanzani-IRCCS, Rome, Italy.
Ann N Y Acad Sci. 2001 Nov;946:223-35. doi: 10.1111/j.1749-6632.2001.tb03915.x.
In recent years, much more thought has been given to the pathogenic role of HIV and to the clinical manifestations of HIV-related pulmonary hypertension (HRPH), which currently represents one of the most severe events during HIV disease. HRPH occurs in early and late stages of HIV infection and does not seem to be related to the degree of immune deficiency. Many of the symptoms in HRPH result from right ventricular dysfunction: the first clinical manifestation is effort intolerance and exertional dyspnea that will progress to the point of breathlessness at rest. The diagnosis of HRPH can be made only after all etiologies for pulmonary hypertension have been excluded. Echocardiography has been proven to be an extremely useful tool for diagnosing HRPH, and Doppler echocardiography can be used to estimate systolic pulmonary artery pressure and to monitor the effects of therapy. Assessment of hemodynamic measures by catheterization remains, however, the best test for evaluating response to therapy. Cardiac catheterization is mandatory to characterize the disease and exclude an underlying cardiac shunt as etiology. Vasodilators have been extensively used in the treatment of pulmonary hypertension, since vasoconstriction is a determinant characteristic of this disease. However, HRPH remains a progressive disease for which treatment is often unsatisfactory and there is no cure. As new, more efficient antiretroviral treatment are introduced, clinicians should expect to encounter an increasing number of cases of pulmonary hypertension in HIV+ patients in the future.
近年来，人们对人类免疫缺陷病毒（HIV）的致病作用以及HIV相关肺动脉高压（HRPH）的临床表现给予了更多关注，HRPH目前是HIV疾病期间最严重的事件之一。HRPH发生在HIV感染的早期和晚期，似乎与免疫缺陷程度无关。HRPH的许多症状是由右心室功能障碍引起的：最初的临床表现是运动不耐受和劳力性呼吸困难，随后会发展为静息时呼吸困难。只有在排除所有导致肺动脉高压的病因后，才能做出HRPH的诊断。超声心动图已被证明是诊断HRPH的极其有用的工具，多普勒超声心动图可用于估计肺动脉收缩压并监测治疗效果。然而，通过导管插入术评估血流动力学指标仍然是评估治疗反应的最佳测试。必须进行心导管检查以明确疾病特征并排除潜在的心脏分流作为病因。由于血管收缩是这种疾病的一个决定性特征，血管扩张剂已被广泛用于治疗肺动脉高压。然而，HRPH仍然是一种进行性疾病，其治疗往往不尽人意，且无法治愈。随着新型、更有效的抗逆转录病毒治疗方法的引入，临床医生预计未来在HIV阳性患者中会遇到越来越多的肺动脉高压病例。
