Mesa R A, Edell E S, Dunn W F, Edwards W D
Department of Internal Medicine, Mayo Clinic Rochester, Minnesota 55905, USA.
Mayo Clin Proc. 1998 Jan;73(1):37-45. doi: 10.1016/S0025-6196(11)63616-1.
In this article, we describe pulmonary hypertension in two men (31 and 43 years of age) with human immunodeficiency virus (HIV) infection who were examined at Mayo Clinic Rochester. Among 88 reported cases (including the two current ones) of HIV- or acquired immunodeficiency syndrome (AIDS)-associated pulmonary hypertension, 61% were male; the age range was 2 to 56 years (mean, 32). Dyspnea was the usual initial symptom. Of the 74 patients in whom pulmonary artery pressure was recorded or calculated by echocardiography, systolic pressures ranged from 49 to 118 mm Hg (mean, 68). Of the 33 cases in which lung tissue was evaluated microscopically, 28 (85%) were of the plexogenic variant of pulmonary arterial hypertension. Of the other five cases examined histologically, three consisted of thrombotic pulmonary arteriopathy (one was due to recurrent thromboembolism, and the other two were due to in situ thrombosis), and two were of pulmonary venoocclusive disease. No correlation existed between either CD4 counts or a history of pulmonary infections and the development of pulmonary hypertension. In 15 of the 88 patients (17%), confounding factors for hypertensive pulmonary vascular disease were present, including coexisting liver disease in 13 and coagulation abnormalities in 2. In 83% of the patients, the development of pulmonary hypertension seems to have been related primarily to the chronic HIV infection. Pulmonary hypertension was more rapidly progressive in patients with HIV or AIDS than in those with primary pulmonary hypertension; the reported time intervals between onset of symptoms and diagnosis were 6 months and 30 months, respectively. The 1-year survival rate for patients with HIV and pulmonary hypertension was 51%, based on the follow-up data compiled from the 63 patients in whom it was described; this compares with a 1-year survival rate of 68% for patients with primary pulmonary hypertension. Death was considered a direct consequence of pulmonary hypertension in 29 (76%) of the 38 fatal cases.
在本文中，我们描述了两名在罗切斯特梅奥诊所接受检查的感染人类免疫缺陷病毒（HIV）的男性（31岁和43岁）的肺动脉高压情况。在88例报告的与HIV或获得性免疫缺陷综合征（AIDS）相关的肺动脉高压病例（包括当前这两例）中，61%为男性；年龄范围为2至56岁（平均32岁）。呼吸困难是常见的初始症状。在74例通过超声心动图记录或计算肺动脉压力的患者中，收缩压范围为49至118毫米汞柱（平均68）。在33例经显微镜评估肺组织的病例中，28例（85%）为动脉性肺动脉高压的丛状型。在其他5例经组织学检查的病例中，3例为血栓性肺血管病（1例因反复血栓栓塞，另外2例因原位血栓形成），2例为肺静脉闭塞性疾病。CD4细胞计数或肺部感染史与肺动脉高压的发生之间均无相关性。在88例患者中的15例（17%）存在高血压性肺血管疾病的混杂因素，包括13例并存肝病和2例凝血异常。在83%的患者中，肺动脉高压的发生似乎主要与慢性HIV感染有关。HIV或AIDS患者的肺动脉高压比原发性肺动脉高压患者进展更快；报告的症状出现至诊断的时间间隔分别为6个月和30个月。根据63例有相关描述的患者的随访数据，HIV合并肺动脉高压患者的1年生存率为51%；相比之下，原发性肺动脉高压患者的1年生存率为68%。在38例死亡病例中，29例（76%）的死亡被认为是肺动脉高压的直接后果。
