Wagenvoort C A
Department of Pathology, Erasmus University, Rotterdam, The Netherlands.
Eur Heart J. 1988 Sep;9 Suppl J:7-12. doi: 10.1093/eurheartj/9.suppl_j.7.
The reversibility of pulmonary hypertension in hypertensive pulmonary vascular disease depends, in the first place, on the feasibility of eliminating the cause of the elevation of pressure. Equally important in this respect are the type, the severity, and the extent of the pulmonary vascular lesions. This implies that various forms of pulmonary hypertension have completely different tendencies for regression. In thrombotic arteriopathy, whether caused by primary thrombosis or by embolism, the chance of regression of pulmonary hypertension, and of the vascular lesions, is limited. On the other hand, in many patients pulmonary venous hypertension and the associated vasculopathy, even when severe, appear potentially reversible. Experimental evidence suggests that the same is true in cases of hypoxic pulmonary hypertension as long as prominent complicating vascular alterations, as often observed in chronic obstructive lung disease, are absent. In plexogenic arteriopathy regression of pulmonary hypertension, following elimination of its cause, is observed whenever the vascular lesions have not progressed beyond a certain stage that can be considered a point of no return. Thereafter, there is not only no regression but a distinct tendency to progression of pulmonary vascular disease.
高血压性肺血管疾病中肺动脉高压的可逆性首先取决于消除压力升高原因的可行性。在这方面同样重要的是肺血管病变的类型、严重程度和范围。这意味着各种形式的肺动脉高压具有完全不同的消退倾向。在血栓性动脉病中，无论是由原发性血栓形成还是栓塞引起，肺动脉高压和血管病变消退的机会都有限。另一方面，在许多患者中，肺静脉高压及相关血管病变即使严重，似乎也具有潜在的可逆性。实验证据表明，只要不存在慢性阻塞性肺疾病中常见的明显并发血管改变，低氧性肺动脉高压的情况也是如此。在致丛性动脉病中，只要血管病变未进展到某个不可逆转的阶段，消除病因后肺动脉高压就会消退。此后，不仅不会消退，而且肺血管疾病有明显的进展倾向。
