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药物性肺动脉高压:临床医生和科学家的入门指南。

Drug-induced pulmonary arterial hypertension: a primer for clinicians and scientists.

机构信息

Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center , Stanford, California.

The Vera Moulton Wall Center for Pulmonary Vascular Medicine, Stanford University Medical Center , Stanford, California.

出版信息

Am J Physiol Lung Cell Mol Physiol. 2018 Jun 1;314(6):L967-L983. doi: 10.1152/ajplung.00553.2017. Epub 2018 Feb 8.

Abstract

Drug-induced pulmonary arterial hypertension (D-PAH) is a form of World Health Organization Group 1 pulmonary hypertension (PH) defined by severe small vessel loss and obstructive vasculopathy, which leads to progressive right heart failure and death. To date, 16 different compounds have been associated with D-PAH, including anorexigens, recreational stimulants, and more recently, several Food and Drug Administration-approved medications. Although the clinical manifestation, pathology, and hemodynamic profile of D-PAH are indistinguishable from other forms of pulmonary arterial hypertension, its clinical course can be unpredictable and to some degree dependent on removal of the offending agent. Because only a subset of individuals develop D-PAH, it is probable that genetic susceptibilities play a role in the pathogenesis, but the characterization of the genetic factors responsible for these susceptibilities remains rudimentary. Besides aggressive treatment with PH-specific therapies, the major challenge in the management of D-PAH remains the early identification of compounds capable of injuring the pulmonary circulation in susceptible individuals. The implementation of pharmacovigilance, precision medicine strategies, and global warning systems will help facilitate the identification of high-risk drugs and incentivize regulatory strategies to prevent further outbreaks of D-PAH. The goal for this review is to inform clinicians and scientists of the prevalence of D-PAH and to highlight the growing number of common drugs that have been associated with the disease.

摘要

药物性肺动脉高压(D-PAH)是世界卫生组织 1 组肺动脉高压(PH)的一种形式,其特征为严重的小血管损失和阻塞性血管病变,导致进行性右心衰竭和死亡。迄今为止,已有 16 种不同的化合物与 D-PAH 相关,包括厌食剂、娱乐性兴奋剂,以及最近几种获得美国食品和药物管理局批准的药物。尽管 D-PAH 的临床表现、病理学和血液动力学特征与其他形式的肺动脉高压无法区分,但它的临床病程可能是不可预测的,在某种程度上取决于是否去除致病药物。由于只有一部分人会发生 D-PAH,因此遗传易感性可能在发病机制中起作用,但负责这些易感性的遗传因素的特征仍处于初级阶段。除了使用 PH 特异性治疗进行积极治疗外,D-PAH 管理的主要挑战仍然是早期识别可能伤害易感个体肺循环的化合物。实施药物警戒、精准医学策略和全球警报系统将有助于识别高危药物,并激励监管策略以防止 D-PAH 的进一步爆发。本综述的目的是让临床医生和科学家了解 D-PAH 的流行情况,并强调越来越多的常见药物与该疾病有关。

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