COPD/emphysema: The vascular story.
COPD/emphysema: The vascular story.
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DOI：
10.4103/2045-8932.87295
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发表时间：
2011-07
影响因子：
2.6
通讯作者：
Mizuno S
中科院分区：
文献类型：
--
作者：
Voelkel NF;Gomez-Arroyo J;Mizuno S
从这个角度来看，我们回顾了支持许多或大多数慢性和进行性肺部疾病也涉及肺血管以及微血管异常和内皮细胞死亡有助于肺气肿病理生物学的观点的已发表数据。肺血管的维持依赖于血管内皮生长因子信号，两者在肺气肿肺组织中都受到损害。虽然低氧肺血管收缩被认为是慢性阻塞性肺疾病（COPD/肺气肿）血管重构的重要因素，但现在清楚的是，吸入的香烟烟雾可以独立于肺血管张力损伤肺血管。我们认为，“肺循环异常”而不是右心后负荷可能更好地解释COPD患者的心脏异常，这通常被概括为“肺心病”。肺动脉高压的机制和原因可能很复杂，包括血管丧失、原位血栓形成和内皮细胞功能障碍。评估肺动脉高压在COPD中的功能重要性需要在运动期间进行血流动力学测量。
In this perspective, we review published data which support the concept that many or most chronic and progressive lung diseases also involve the lung vessels and that microvascular abnormalities and endothelial cell death contribute to the pathobiology of emphysema. Lung vessel maintenance depends on Vascular Endothelial Growth Factor signaling and both are compromised in the emphysematous lung tissue. Although hypoxic pulmonary vasoconstriction has been considered as an important factor contributing to the vascular remodeling in chronic obstructive pulmonary disease (COPD) (COPD/emphysema, it is now clear that inhaled cigarette smoke can damage the lung vessels independent of the lung vascular tone. We propose that a “sick lung circulation” rather than the right heart afterload may better explain the cardiac abnormalities in COPD patients which are usually summarized with the term “cor pulmonale.” The mechanisms and causes of pulmonary hypertension are likely complex and include vessel loss, in situ thrombosis, and endothelial cell dysfunction. Assessment of the functional importance of pulmonary hypertension in COPD requires hemodynamic measurements during exercise.