Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA; Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA; Louisiana Addiction Research Center, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA.
Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA; Louisiana Addiction Research Center, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA; Department of Pharmacology, Toxicology & Neuroscience, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA.
Chest. 2024 Jun;165(6):1518-1533. doi: 10.1016/j.chest.2024.01.014. Epub 2024 Jan 9.
The global surge in methamphetamine use is a critical public health concern, particularly due to its robust correlation with methamphetamine-associated pulmonary arterial hypertension (MA-PAH). This association raises urgent alarms about the potential escalation of MA-PAH incidence, posing a significant and imminent challenge to global public health.
This comprehensive review meticulously explores MA-PAH, offering insights into its epidemiology, pathophysiology, clinical presentation, diagnostic intricacies, and management strategies. The pathogenesis, yet to be fully described, involves complex molecular interactions, including alterations in serotonin signaling, reduced activity of carboxylesterase 1, oxidative stress, and dysregulation of pulmonary vasoconstrictors and vasodilators. These processes culminate in the structural remodeling of the pulmonary vasculature, resulting in pulmonary arterial hypertension. MA-PAH exhibits a more severe clinical profile in functional class and hemodynamics compared with idiopathic pulmonary arterial hypertension. Management involves a multifaceted approach, integrating pulmonary vasodilators, cessation of methamphetamine use, and implementing social and rehabilitation programs. These measures aim to enhance patient outcomes and detect potential relapses for timely intervention.
This review consolidates our understanding of MA-PAH, pinpointing knowledge gaps for future studies. Addressing these gaps is crucial for advancing diagnostic accuracy, unraveling mechanisms, and optimizing treatment for MA-PAH, thereby addressing the evolving landscape of this complex health concern.
主题重要性：全球范围内甲基苯丙胺使用的激增是一个严重的公共卫生问题，特别是因为它与甲基苯丙胺相关的肺动脉高压（MA-PAH）密切相关。这种关联引发了对 MA-PAH 发病率可能升级的紧急警报，对全球公共卫生构成了重大且迫在眉睫的挑战。
综述发现：本综述全面探讨了 MA-PAH，深入了解其流行病学、病理生理学、临床表现、诊断复杂性和管理策略。其发病机制尚未完全描述，涉及复杂的分子相互作用，包括 5-羟色胺信号的改变、羧酯酶 1 活性降低、氧化应激以及肺血管收缩和舒张调节剂的失调。这些过程最终导致肺血管结构重塑，导致肺动脉高压。与特发性肺动脉高压相比，MA-PAH 在功能分级和血液动力学方面表现出更严重的临床特征。治疗涉及多方面的方法，包括肺血管扩张剂、停止使用甲基苯丙胺以及实施社会和康复计划。这些措施旨在改善患者的预后，并发现潜在的复发情况以便及时干预。
总结：本综述整合了我们对 MA-PAH 的理解，指出了未来研究的知识空白。解决这些空白对于提高诊断准确性、揭示机制以及优化 MA-PAH 的治疗至关重要，从而应对这一复杂健康问题不断变化的局面。
