慢性阻塞性肺疾病合并肺动脉高压的发病机制研究进展

Advances in pathogenesis of pulmonary hypertension in chronic obstructive pulmonary disease

肺动脉高压（pulmonary hypertension，PH）是慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）的一个重要合并症。COPD合并PH是逐渐发生和进展的，最初于运动或睡眠时出现，逐渐发展为休息时即存在PH，运动、睡眠或病情恶化时进一步升高。COPD相关的PH多为轻到中度，但某些COPD患者可表现为“不成比例”的PH。香烟烟雾、炎症产物引起内皮损害，造成内皮功能失调；慢性低氧引起肺血管收缩；肺血管重构导致管腔变小，血管膨胀性降低，阻力增加；重度肺气肿时肺毛细血管的丧失等均与COPD时的PH相关。

Pulmonary hypertension（PH） is a common complication of chronic obstructive pulmonary disease（COPD）. In COPD,PH progresses slowly. It may firstly appear during exercise and during sleep,then at rest, and worsen during exercise, sleep or exacerbation. PH in COPD is usually mild to moderate. However,a small proportion of COPD patients may present with ＂out of proportion＂ PH. Cigarette smoke components or inflammation products may damage endothelial cells and produce endothelial dysfunction. Hypoxia may induce vasoconstriction. Pulmonary vascular remodeling leads to reduction of arterial lumen and distensibility of the pulmonary vessels, which increase pulmonary vascular resistance. Severe emphysema leads to reduction in the total number of pulmonary vessels. All these contribute to the development of PH in COPD.