UCD School of Medicine, Conway Institute, Dublin, Ireland.
UCD School of Medicine, Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland.
Lancet Respir Med. 2016 Mar;4(3):225-36. doi: 10.1016/S2213-2600(15)00517-2. Epub 2016 Feb 16.
Pulmonary hypertension is a well recognised complication of chronic hypoxic lung diseases, which are among the most common causes of death and disability worldwide. Development of pulmonary hypertension independently predicts reduced life expectancy. In chronic obstructive pulmonary disease, long-term oxygen therapy ameliorates pulmonary hypertension and greatly improves survival, although the correction of alveolar hypoxia and pulmonary hypertension is only partial. Advances in understanding of the regulation of vascular smooth muscle tone show that chronic vasoconstriction plays a more important part in the pathogenesis of hypoxic pulmonary hypertension than previously thought, and that structural vascular changes contribute less. Trials of existing vasodilators show that pulmonary hypertension can be ameliorated and systemic oxygen delivery improved in carefully selected patients, although systemic hypotensive effects limit the doses used. Vasoconstrictor pathways that are selective for the pulmonary circulation can be blocked to reduce hypoxic pulmonary hypertension without causing systemic hypotension, and thus provide potential targets for novel therapeutic strategies.
肺动脉高压是慢性低氧性肺部疾病的一种公认并发症，这些疾病是全球最常见的死亡和残疾原因之一。肺动脉高压的发展独立预测了预期寿命的缩短。在慢性阻塞性肺疾病中，长期氧疗可改善肺动脉高压并显著提高生存率，尽管对肺泡缺氧和肺动脉高压的纠正只是部分的。对血管平滑肌张力调节的认识的进展表明，慢性血管收缩在低氧性肺动脉高压的发病机制中起着比以前认为更重要的作用，而结构血管变化的作用较小。现有的血管扩张剂试验表明，在精心挑选的患者中可以改善肺动脉高压并提高全身氧输送，尽管全身降压作用限制了所用剂量。选择性阻断肺血管的血管收缩途径可以减少低氧性肺动脉高压而不引起全身低血压，从而为新的治疗策略提供潜在的靶点。
