早产儿支气管肺发育不良相关肺动脉高压治疗进展

Treatment progress of pulmonary hypertension associated with bronchopulmonary dysplasia in preterm infants

肺动脉高压(pulmonary hypertension,PH)在支气管肺发育不良(bronchopulmonary dysplasia,BPD)的早产儿中并不少见,并且与病死率显著相关,其病理生理基础为肺血管发育异常、结构重塑以及气道反应性过高。目前对于BPD-PH,综合支持治疗是基础,靶向治疗药物是关键,即应用各种不同作用机制的肺血管扩张剂,如磷酸二酯酶抑制剂、内皮素受体拮抗剂和前列腺素。尽管专家共识建议使用靶向药物降低肺动脉压力,但关于这些药物安全性和有效性的高质量临床研究数量有限,肺血管重塑抑制剂及干细胞治疗具备一定的潜力,尚需进一步的研究及数据支持。

Pulmonary hypertension(PH)is commonly seen in preterm infants with bronchopulmonary dysplasia(BPD)and is significantly associated with increased mortality.The pathophysiological basis of PH is pulmonary vascular dysplasia or remodeling,and airways hyperresponsiveness.At present,management of BPD-PH should be comprehensive supportive therapy and focus on targeted pharmacotherapies,including various pulmonary vasodilators with different vasoactive mechanisms,such as phosphodiesterase inhibitors,endothelin receptor antagonists and prostaglandins analogs.However,although expert consensus recommends targeted pulmonary arterial hypertension therapy,high-quality clinical studies on the safety and efficacy of these drugs are few.Pulmonary vascular remodeling inhibitors and stem cell therapy have enormous potential to reduce pulmonary hypertension and further research and more data are needed.