Hovnanian A, Hoette S, Fernandes C J C, Jardim C, Souza R
Pulmonary Department, Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil.
Int J Clin Pract Suppl. 2010 Jan(165):25-8. doi: 10.1111/j.1742-1241.2009.02234.x.
Schistosomiasis is one of the most prevalent infectious diseases, endemic in more than 70 countries, mainly within the developing world. More than 200 million people might be infected worldwide; about 20 million of those might develop severe disease. The hepatosplenic form of schistosomiasis is the most prevalent form of chronic disease, characterised by the presence of periportal fibrosis and portal hypertension. Pulmonary hypertension is a well-recognised complication of hepatosplenic schistosomiasis. Recent prevalent studies revealed that schistosomiasis patients may develop precapillary and postcapillary forms of pulmonary hypertension, reinforcing the role of invasive haemodynamic measurements for the proper diagnosis. These studies also demonstrated that schistosomiasis associated pulmonary arterial hypertension may represent the most prevalent form of pulmonary arterial hypertension (PAH). Many aspects regarding the appropriate management of Sch-PAH patients still remain to be elucidated, as the use of specific PAH therapy. Although the ongoing control programmes that started within the 1980s have clearly improved the schistosomiasis cenario worldwide, Sch-PAH will be seen for decades after proper control is reached, strengthening the current need for comprehensive studies aiming to clarify the multiple mechanisms involved in the pathophysiology of this particular subgroup of PAH.
血吸虫病是最常见的传染病之一，在70多个国家呈地方性流行，主要在发展中世界。全球可能有超过2亿人感染；其中约2000万人可能发展为严重疾病。肝脾型血吸虫病是最常见的慢性疾病形式，其特征是门周纤维化和门静脉高压的存在。肺动脉高压是肝脾型血吸虫病公认的并发症。最近的流行研究表明，血吸虫病患者可能会出现毛细血管前和毛细血管后型肺动脉高压，这进一步强调了有创血流动力学测量在正确诊断中的作用。这些研究还表明，血吸虫病相关的肺动脉高压可能是最常见的肺动脉高压（PAH）形式。关于血吸虫病相关肺动脉高压（Sch-PAH）患者的适当管理，许多方面仍有待阐明，比如特异性PAH治疗的使用。尽管始于20世纪80年代的现行控制项目已明显改善了全球血吸虫病的状况，但在实现适当控制后的几十年里仍会见到Sch-PAH病例，这凸显了当前进行全面研究的必要性，旨在阐明参与这种特殊类型PAH病理生理学的多种机制。
