Severe pulmonary hypertension in postmenopausal obese women.
Severe pulmonary hypertension in postmenopausal obese women.
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发表时间：
2006-05
影响因子：
4.2
通讯作者：
A. Taraseviciute;N. Voelkel
中科院分区：
文献类型：
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作者：
A. Taraseviciute;N. Voelkel
背景严重肺动脉高压（PH）是一种罕见的疾病，由多种因素和疾病引发，具有共同的病理生理学特征。二十年前，人们普遍认为“原发性”（特发性）肺动脉高压（PPH）是一种年轻女性的疾病。然而，我们最近在UCHSC肺动脉高压中心注意到，患有严重PH的女性经常是绝经后和超重或肥胖。目的：确定重度PH是否不仅是年轻女性的疾病，也是超重或肥胖的绝经后女性的疾病。设计、地点和参与者对UCHSC肺动脉高压中心的541例绝经后女性患者的病历进行了回顾。根据原发性或继发性PH的诊断，将患者分为两组。主要观察指标：绝经后重度PH妇女的病历进一步回顾糖尿病史、全身性高血压史、抗抑郁药使用史、激素替代治疗史、抗抑郁药与激素替代治疗的联合用药史以及前列环素。记录这些患者的实验室数据，如胆固醇升高、尿酸升高和C反应蛋白（CRP）升高，以及体格检查数据，以确定患者的体重指数（BMI）。结果在UCHSC肺动脉高压中心的所有肺动脉高压女性患者中，56%为绝经后患者。39%的绝经后PPH妇女和48%的继发重度PH妇女肥胖。此外，绝经后肥胖妇女经常有系统性高血压，并在激素替代治疗以及抗抑郁药物。结论：肥胖、激素替代治疗和抗抑郁治疗可能导致遗传易感妇女发生重度PH。进一步的调查，在一个前瞻性的，病例对照研究的形式，需要确定这些因素是否在绝经后妇女发挥致病作用。
CONTEXT Severe pulmonary hypertension (PH) is a rare disorder triggered by a variety of factors and disease conditions and characterized by a shared pathophysiology. Two decades ago it was widely held that "primary" (idiopathic) pulmonary hypertension (PPH) is a disease of young women. However, we noticed recently in the UCHSC Pulmonary Hypertension Center that women with severe PH are frequently postmenopausal and overweight or obese. OBJECTIVES To determine whether severe PH is a disease not only of young women but also of postmenopausal women who are overweight or obese. DESIGN, SETTING, AND PARTICIPANTS The medical records of 541 postmenopausal female patients at the UCHSC Pulmonary Hypertension Center were reviewed. The patients were divided into two groups based on their diagnosis of either primary or secondary PH. MAIN OUTCOME MEASURES The medical records of postmenopausal women with severe PH were further reviewed for history of diabetes, systemic hypertension, and the use of anti-depressants, hormone replacement therapy, combination of anti-depressants and hormone replacement therapy, as well as anorexigens. Laboratory data such as elevated cholesterol, elevated uric acid, and elevated C-reactive protein (CRP) were recorded in these patients, as well as physical exam data to determine the body-mass index (BMI) of the patients. RESULTS 56% of all pulmonary hypertensive women who were patients at the UCHSC Pulmonary Hypertension Center were postmenopausal. 39% of postmenopausal women with PPH and 48% with secondary severe PH were obese. In addition, postmenopausal obese women frequently had systemic hypertension and were on hormone replacement therapy as well as antidepressant medication. CONCLUSIONS Obesity, hormone replacement therapy and anti-depressant therapy may contribute to the development of severe PH in genetically predisposed women. Further investigation, in the form of a prospective, case-control study, is needed to determine whether these factors exert a causative effect in postmenopausal women.