重叠综合征相关性肺动脉高压研究进展

Research progress of overlap syndrome associated pulmonary hypertension

阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome,OSAS）和 COPD 是常见的呼吸系统疾病,二者并存率很高,称为重叠综合征（overlap syndrome, OS）,肺动脉高压（pulmonary hypertension,PH）是两者的常见并发症。COPD 患者伴口咽部为主的上呼吸道阻塞可导致 OSAS 的发生,COPD 相关的 PH 多为香烟烟雾、炎症产物引起内皮损害,致内皮功能失调,慢性低氧导致血管收缩,肺血管重塑导致管腔变小,血管阻力增加,重度肺气肿时肺毛细血管的丧失都与COPD 时的 PH 相关。而 OSAS 主要为间歇性低氧（intermittent hypoxia,IH）状态导致 PH,很多研究显示持续性低氧与 IH 状态可导致 PH,而 OS 与单纯 COPD 或 OSAS 相比,其夜间低氧及高碳酸血症更严重,更易发生 PH,增加病死率。本文将就 OS 导致 PH 的可能发病机制作一综述。

Obstructive sleep apnea syndrome（OSAS） and chronic obstructive pulmonary disease （COPD） are common respiratory diseases,the combination of them calls overlap syndrome （OS）,the coexistence rate of them is high and pulmonary hypertension （PH） is a common complication of both. COPD patients with oropharyngeal upper airway obstruction can lead to the occurrence of OSAS. Endothelial damage and endothelial dysfunction caused by cigarette smoke,inflammatory products, vasoconstriction caused by chronic hypoxia,smaller lumens caused by pulmonary vascular remodeling, vascular resistance increases and capillary loss caused by severe emphysema pulmonary are associated with COPD-related PH.While OSAS-related PH is mainly caused by intermittent hypoxia（IH）,many studies have shown that persistent hypoxia and IH can lead to PH.Compared with COPD or OSAS alone,the nocturnal hypoxia and hypercapnia of OS is severer and OS is prone to PH.Also OS can increase mortality.This article will review the possible pathogenesis of OS-related PH.