1 Division of Pulmonary and Critical Care Medicine.
2 Vera Moulton Wall Center for Pulmonary Vascular Disease at Stanford, and.
Am J Respir Crit Care Med. 2018 Mar 15;197(6):788-800. doi: 10.1164/rccm.201705-0943OC.
Although amphetamines are recognized as "likely" agents to cause drug- and toxin-associated pulmonary arterial hypertension (PAH), (meth)amphetamine-associated PAH (Meth-APAH) has not been well described.
To prospectively characterize the clinical presentation, histopathology, and outcomes of Meth-APAH compared with those of idiopathic PAH (iPAH).
We performed a prospective cohort study of patients with Meth-APAH and iPAH presenting to the Stanford University Pulmonary Hypertension Program between 2003 and 2015. Clinical, pulmonary angiography, histopathology, and outcomes data were compared. We used data from the Healthcare Cost and Utilization Project to estimate the epidemiology of PAH in (meth)amphetamine users hospitalized in California.
The study sample included 90 patients with Meth-APAH and 97 patients with iPAH. Patients with Meth-APAH were less likely to be female, but similar in age, body mass index, and 6-minute-walk distance to patients with iPAH. Patients with Meth-APAH reported more advanced heart failure symptoms, had significantly higher right atrial pressure (12.7 ± 6.8 vs. 9.8 ± 5.1 mm Hg; P = 0.001), and had lower stroke volume index (22.2 ± 7.1 vs. 25.5 ± 8.7 ml/m; P = 0.01). Event-free survival in Meth-APAH was 64.2%, 47.2%, and 25% at 2.5, 5, and 10 years, respectively, representing more than double the risk of clinical worsening or death compared with iPAH (hazard ratio, 2.04; 95% confidence interval, 1.28-3.25; P = 0.003) independent of confounders. California data demonstrated a 2.6-fold increase in risk of PAH diagnosis in hospitalized (meth)amphetamine users.
Meth-APAH is a severe and progressive form of PAH with poor outcomes. Future studies should focus on mechanisms of disease and potential therapeutic considerations.
尽管安非他命被认为是“可能”导致药物和毒素相关肺动脉高压（PAH）的药物，但（甲基）安非他命相关 PAH（Meth-APAH）尚未得到充分描述。
前瞻性描述 Meth-APAH 与特发性 PAH（iPAH）相比的临床表现、组织病理学和结局。
我们对 2003 年至 2015 年期间在斯坦福大学肺动脉高压项目就诊的 Meth-APAH 和 iPAH 患者进行了前瞻性队列研究。比较了临床、肺动脉造影、组织病理学和结局数据。我们使用医疗保健成本和利用项目的数据来估计加利福尼亚州因使用（甲基）安非他命住院的 PAH 流行病学。
研究样本包括 90 例 Meth-APAH 患者和 97 例 iPAH 患者。Meth-APAH 患者中女性比例较低，但与 iPAH 患者的年龄、体重指数和 6 分钟步行距离相似。Meth-APAH 患者报告的心力衰竭症状更严重，右心房压显著升高（12.7±6.8 与 9.8±5.1mmHg；P=0.001），而每搏输出量指数较低（22.2±7.1 与 25.5±8.7ml/m；P=0.01）。Meth-APAH 的无事件生存分别为 2.5、5 和 10 年时的 64.2%、47.2%和 25%，与 iPAH 相比，临床恶化或死亡的风险增加了两倍以上（危险比，2.04；95%置信区间，1.28-3.25；P=0.003），独立于混杂因素。加利福尼亚州的数据显示，住院（甲基）安非他命使用者的 PAH 诊断风险增加了 2.6 倍。
Meth-APAH 是一种严重且进行性的 PAH，预后不良。未来的研究应集中于疾病的发病机制和潜在的治疗考虑。
