在临床实践中轻度肺高血压的管理
Katarina Zeder1,2,3,4, Evan Brittain5, Gabor Kovacs1
1Department of Pulmonology, Medical University of Graz and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.
肺高血压 (PH) 的定义得到了更新,降低了肺动脉平均压力 (mPAP) 的值. 这一修订后的定义涵盖了更多的患者,需要仔细考虑轻度PH病例.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 医学诊断 医学诊断 医学诊断
背景情况:
- 最近对肺高血压 (PH) 定义的修订使肺动脉平均压力 (mPAP) 门从>=25 mmHg降至>20 mmHg.
- 这种调整与mPAP的正常的上限保持一致,并确定与不良结果相关的较低值.
- 前毛细血管PH的诊断现在包括一个较低的肺血管阻力 (PVR) 门>2.0木单位 (WU),从>3.0WU.
研究的目的:
- 解决修订PH定义对诊断和管理的影响,特别是对于轻度PH病例.
- 为管理轻度PH (mPAP 21-24 mmHg和PVR 2-3 WU) 患者的临床医生提供实际指导.
- 在一个问题/答案格式中讨论轻度PH管理的关键领域.
主要方法:
- 对肺高血压 (PH) 的定义最近的更新进行了审查.
- 对修订的血液动力学值 (mPAP和PVR) 对患者分类的影响分析.
- 基于更新的标准,讨论轻度PH的管理策略.
主要成果:
- 预计修订后的PH定义将识别大约55%的更多患者.
- 前毛细血管PH的新标准降低了肺血管抵抗的诊断值.
- 支持肺血管扩张器治疗的临床试验使用了较旧的血液动力学定义,需要对新归类的轻度PH患者进行仔细考虑.
结论:
- 更新的PH定义需要仔细的临床考虑,特别是对于轻度PH的患者.
- 轻度PH的管理策略需要适应新的诊断标准.
- 为临床医生提供了有效管理轻度PH的指导,考虑到现有试验数据的局限性.
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