Department of Pulmonary Medicine, Hospital del Mar.
Department of Pulmonary Medicine, Hospital Clínic, Barcelona.
Curr Opin Pulm Med. 2023 Sep 1;29(5):370-379. doi: 10.1097/MCP.0000000000000984. Epub 2023 Jun 30.
Pulmonary hypertension (PH) is a common complication of both chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD), classified as Group 3 PH. To which extent PH presents and behaves similarly in COPD and ILD is unclear. This review examines the similarities and differences in pathogenesis, clinical presentation, natural history and treatment response of PH in COPD and ILD.
The latest studies on PH in chronic lung disease have re-evaluated the role of traditionally held etiopathogenetic factors such as tobacco exposure and hypoxia, although new ones such as airborne pollutant and genetic mutations are increasingly recognized. We examine common and diverging factors involved in PH development in COPD and ILD, as well as common and diverging clinical features of presentation, natural history and response to treatment and highlight areas for future research.
The development of PH in lung disease significantly worsens the morbidity and mortality of patients with COPD and ILD. However, recent findings show importance of recognizing distinct patterns and behaviors of pulmonary vascular disease, taking into account the specific underlying lung disease and severity of the hemodynamic involvement. Further studies are needed to build evidence on these aspects, especially in early disease.
肺动脉高压(PH)是慢性阻塞性肺疾病(COPD)和间质性肺疾病(ILD)的常见并发症,被归类为第 3 组 PH。PH 在 COPD 和 ILD 中的表现和行为方式在多大程度上相似尚不清楚。这篇综述检查了 PH 在 COPD 和 ILD 中的发病机制、临床表现、自然史和治疗反应方面的相似和不同之处。
关于慢性肺部疾病中 PH 的最新研究重新评估了传统上认为的发病因素,如烟草暴露和缺氧的作用,尽管越来越多的新因素,如空气传播污染物和基因突变,也被认识到。我们检查了 COPD 和 ILD 中 PH 发展中涉及的共同和不同的因素,以及表现、自然史和治疗反应方面的共同和不同的临床特征,并强调了未来研究的领域。
肺部疾病中 PH 的发展显著增加了 COPD 和 ILD 患者的发病率和死亡率。然而,最近的研究结果表明,有必要认识到肺血管疾病的不同模式和行为,同时考虑到特定的基础肺部疾病和血液动力学受累的严重程度。需要进一步的研究来建立这些方面的证据,特别是在疾病早期。