Gaynitdinova V V, Avdeev S N
Pulmonology Research Institute.
Sechenov First Moscow State Medical University (Sechenov University); Pulmonology Research Institute.
Kardiologiia. 2019 Jul 19;59(7):84-94. doi: 10.18087/cardio.2019.7.10259.
Pulmonary hypertension (PH) is a clinical syndrome characterized by a progressive increase in pulmonary vascular resistance (PVR), which leads to remodeling of the right ventricle (RV), right heart failure and premature death of patients. Early diagnosis and monitoring of disease progression are crucial for making decisions about the necessary therapy. The gold standard for the diagnosis of pulmonary hypertension is the right heart catheterization. The estimation of systolic pressure in pulmonary artery by means of transthoracic echocardiography is also used for monitoring the course of the disease. At present, there is still a need for non-invasive biomarkers that reflect pathological changes in pulmonary arterial vessels and allow diagnosing of PH. Our review outlines the new data about some biomarkers potentially useful for diagnosis and prognostication of PH. These biomarkers (mid-regional pro-adrenomedullin, carboxyterminal pro-endothelin-1, copeptin, asymmetric dimethylarginine, growth differentiation factor 15, and others) are classified based on their relationship to endothelial cell dysfunction, inflammation, epigenetics, cardiac function, oxidative stress, extracellular matrix. The determination of biomarkers that are of diagnostic value for predicting the severity, progression of PH and response to therapy, in a simple blood test or condensate of exhaled air, can significantly reduce treatment costs and improve PH management.
肺动脉高压(PH)是一种临床综合征,其特征为肺血管阻力(PVR)进行性增加,进而导致右心室(RV)重塑、右心衰竭以及患者过早死亡。疾病的早期诊断和病情进展监测对于做出必要治疗决策至关重要。肺动脉高压诊断的金标准是右心导管检查。通过经胸超声心动图估计肺动脉收缩压也用于监测疾病进程。目前,仍需要能够反映肺动脉血管病理变化并有助于诊断肺动脉高压的非侵入性生物标志物。我们的综述概述了一些可能对肺动脉高压诊断和预后有潜在作用的生物标志物的新数据。这些生物标志物(中段前肾上腺髓质素、羧基末端前内皮素-1, copeptin、不对称二甲基精氨酸、生长分化因子15等)根据它们与内皮细胞功能障碍、炎症、表观遗传学、心脏功能、氧化应激、细胞外基质的关系进行分类。通过简单的血液检测或呼出空气冷凝物来测定对预测肺动脉高压的严重程度、病情进展及治疗反应具有诊断价值的生物标志物,可显著降低治疗成本并改善肺动脉高压的管理。