左心疾病相关性肺动脉高压诊疗简况
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摘要
左心疾病相关性肺动脉高压属"肺胀""痰饮"等范畴。以右心导管检查为诊断金标准,以控制体力活动,避免劳动、抗凝等治疗为主,靶向治疗以前列环素、内皮受体拮抗剂、磷酸二酯酶·5抑制剂、Rho激酶抑制剂、5-羟色胺受体拮抗剂、血管活性肠肽等为主,存在一定副作用。药研制使PAH治疗出现新曙光,给患者带来希望,不仅是过去的改善病因治疗,还包含对症治疗、非特异性扩张血管药物和新的靶向治疗药物。严重PAH-LHD患者建议联合用药,方案仍在研究中。中医特色治疗更是为PAH患者带来福音,益气化瘀祛痰、温肾健脾利水、清肺化痰降逆平喘,疗效显著,副作用;尤其在缓解期,阻止病情发展和反复加重、改善和提高生活质量、改善预后等具有重要价值。未来研究期望中西结合,发挥更大作用。
Left heart disease correlation between pulmonary hypertension is a "lung distension" "phlegm retention" category. In order to the right catheterization for the gold standard,to control the physical activity,avoid labor, such as anticoagulant therapy mainly. Targeted therapy with PG12, AT1, PDE5, Rho kinase inhibitors, tyrosine kinase inhibitors, 5HT receptor antagonist, vasoactive intestinal peptide, but there are some side effects. Medicine developed new dawn to appear PAH treatment, it hopes to patients. Therapy on the etiologies is not only the improvement of the past, still include symptomatic treatment, nonspecific dilate blood vessels andnew targeted therapeutic drugs. Patients with severe PAH-LHD suggest combination, plan is still in the study.Characteristics of traditional Chinese medicine treatment for PAH patients brought the gospel. Such as activing blood expectorant, warming kidney and tonifying spleen and eliminating damp, clear lung phlegm inverse and asthma, it brings effective in treatment. Especially in remission, prevent disease progression and repetitive compound, improve and enhance the quality of life and improve the prognosis is of important value. Future research expectation of Chinese and western union, can play an important role.
Left heart disease correlation between pulmonary hypertension is a "lung distension" "phlegm retention" category. In order to the right catheterization for the gold standard,to control the physical activity,avoid labor, such as anticoagulant therapy mainly. Targeted therapy with PG12, AT1, PDE5, Rho kinase inhibitors, tyrosine kinase inhibitors, 5HT receptor antagonist, vasoactive intestinal peptide, but there are some side effects. Medicine developed new dawn to appear PAH treatment, it hopes to patients. Therapy on the etiologies is not only the improvement of the past, still include symptomatic treatment, nonspecific dilate blood vessels andnew targeted therapeutic drugs. Patients with severe PAH-LHD suggest combination, plan is still in the study.Characteristics of traditional Chinese medicine treatment for PAH patients brought the gospel. Such as activing blood expectorant, warming kidney and tonifying spleen and eliminating damp, clear lung phlegm inverse and asthma, it brings effective in treatment. Especially in remission, prevent disease progression and repetitive compound, improve and enhance the quality of life and improve the prognosis is of important value. Future research expectation of Chinese and western union, can play an important role.
引文
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[18]Petkov V,Mosgoeller W,Ziesche R,eta1.Vasoactive intestinal peptide as a new drug for treatment of primary pulmonary hypertension[J].J Clin Invest,2003,111(9):1339-1346.
[19]李冀.方剂学[M].北京:北京中国中医药出版社,2006.
[2]3rd Word PAH Symposium.Pulmonary arterial hypertension:E pidemiology,pathobiology,assessment and therapy[J].J Am Coll Cardiol,2004,43(Suppl):81-90.
[3]荆志成,徐希奇.肺动脉高压现代分类和诊断策略[J].中华心血管杂志,2004,32(12):1160-1162.
[4]Diagnosis and management of pulmonary artial hypertension:ACCP evidence based clinical practice guidlince[J].Chest,2004,126:1S-92S.
[5]Badesch DB,Abman SH,Aheam GS,etal.Medical therapy for pulmonary arterial hypertension:ACCP evidence based clinical practice gidelines[J].Chest,2004,126(1):35-62.
[6]Fuster V,Steele PM,Edwards WD,et al.Primary pulmonary hyper tension:naturalhistory and the importance of thrombosis[J].Circulation,1984,70:580-587.
[7]Judge EP,Gaine SP.Management of pulmonary arterial hypertension[J].Curr Opin Crit Care,2013,19(1):44-50.
[8]Zhang M,Chen M,Kim JR,et al.SWI/SNF complexes containing Brahma or Brahma—related gene 1 play distinct roles in smooth muscle development[J].Mol Cell Biol,2011,31(13):2618-2631.
[9]荆志成,徐希奇.肺动脉高压.心血管病诊疗指南解读[M].北京:人民卫生出版社,2004:507-515.
[10]Yui Y,Nakajima H,Kawai C,et al.Prostacyclin therapy in patients with congestive heart failure[J].Am J Cardiol,1982,50(2):320-324.
[11]Channick RN,Sinonneau G,Sitbon O,etal.Effects of the dual endothelin-receptor antagonist bosentan in patients with pulnoary hypertensiont a randomized placebo-controlled study[J].Lancet,2001,358:1119-1123.
[12]Fukumoto Y,Matoba T,Ito A,et al.Acute vasodilator effect of a Rho2kinase inhibitor,fasudil inpatients with severe pulmonary hypretension[J].Heart,2005,91:391-392.
[13]Dempsie Y,Mac Lean MR.Pulmonary hypertension:therapeutic targets within the serotonin system[J].Br J Pharmacol,2008,155(4):455-462.
[14]田代华,刘更生.灵枢经校注[M].北京:人民军医出版社,2001:140.
[15]牛兵占,肖正权.黄帝内经素问译注[M].北京:中医古籍出版社,2003:140.
[16]赵佶.圣济总录[M].王振国,杨金萍,编校.北京:人民卫生出版社,1998:981.
[17]胡国臣.朱丹溪医学全书[M].北京:中国中医药出版社,2006:118.
[18]Petkov V,Mosgoeller W,Ziesche R,eta1.Vasoactive intestinal peptide as a new drug for treatment of primary pulmonary hypertension[J].J Clin Invest,2003,111(9):1339-1346.
[19]李冀.方剂学[M].北京:北京中国中医药出版社,2006.