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[门肺高压的临床特征及靶向药物治疗分析]

[Analysis of clinical features and targeted drug therapy of portopulmonary hypertension].

作者信息

Yang S Q, Yang Y H, Kuang T G, Liu L, Gong J N, Ding Y, He J G

机构信息

Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing 100020, China.

State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2019 Sep 24;99(36):2806-2810. doi: 10.3760/cma.j.issn.0376-2491.2019.36.002.

Abstract

To analyze the clinical characteristics and the effect of targeted drug therapy of portopulmonary hypertension (PoPH). A total of 5 patients with PoPH who were admitted to the Department of Pulmonary and Critical Care Medicine of Beijing Chao-Yang Hospital from January 1, 2017 to December 31, 2018 were included. The clinical information and follow-up data were collected. The patient's medical history, clinical manifestations, right cardiac catheterization (RHC), classification of cardiac and hepatic function, treatment and prognosis were analyzed. Among the 5 patients with PoPH, 3 were male and 2 were female. The median age was 56 years. The underlying diseases of portal hypertension were all cirrhosis, and 1 patient combined with hepatopulmonary syndrome (HPS). Dyspnea was the main respiratory symptom in all the 5 patients, and the median time from symptom onset to diagnosis was 1 year (5 months to 8 years). RHC was used as the diagnostic criteria for pulmonary hypertension in all patients, with a median mean pulmonary arterial pressure of 42 mmHg (1 mmHg=0.133 kPa) and a median pulmonary vascular resistance of 538 dyn·s·cm(-5). 3 cases were in Child-Pugh liver function grade B, and 2 were in grade A. The hepatic reserve function was not matched with the severity of cardiac insufficiency. Liver transplantation was performed in 1 patient, whose right ventricular dysfunction can be alleviated by targeted drug therapy after operation. All the 5 patients received targeted drug therapy of pulmonary hypertension. In the 3 patients who were regularly treated with targeted drugs and followed up on time, the cardiac function was improved during the follow-up period. There was no improvement or even deterioration of cardiac function in 2 patients who were not regularly treated or followed up. One patient died after liver transplantation. The cause of death was severe pneumonia and right ventricular dysfunction. The survival time after transplantation was 1 year. In PoPH patients, the hepatic reserve function is not matched with the heart function classification. PoPH can coexist with HPS. Regular application of pulmonary hypertension targeting drugs may benefit patients with PoPH.

摘要

分析门静脉高压性肺动脉高压(PoPH)的临床特征及靶向药物治疗效果。纳入2017年1月1日至2018年12月31日在北京朝阳医院呼吸与危重症医学科住院的5例PoPH患者。收集临床资料及随访数据,分析患者病史、临床表现、右心导管检查(RHC)、心功能及肝功能分级、治疗及预后情况。5例PoPH患者中,男性3例,女性2例,中位年龄56岁。门静脉高压的基础疾病均为肝硬化,1例合并肝肺综合征(HPS)。5例患者均以呼吸困难为主要呼吸症状,症状出现至诊断的中位时间为1年(5个月至8年)。所有患者均以RHC作为肺动脉高压的诊断标准,平均肺动脉压中位值为42 mmHg(1 mmHg = 0.133 kPa),肺血管阻力中位值为538 dyn·s·cm⁻⁵。Child-Pugh肝功能分级B级3例,A级2例。肝脏储备功能与心功能不全严重程度不匹配。1例患者行肝移植,术后靶向药物治疗可缓解右心室功能障碍。5例患者均接受了肺动脉高压靶向药物治疗。3例规律接受靶向药物治疗并按时随访的患者,随访期间心功能改善。2例未规律治疗或未随访的患者心功能无改善甚至恶化。1例患者肝移植后死亡,死因是严重肺炎及右心室功能障碍,移植后生存时间为1年。在PoPH患者中,肝脏储备功能与心功能分级不匹配。PoPH可与HPS共存。规律应用肺动脉高压靶向药物可能使PoPH患者获益。

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