Gender, sex hormones and pulmonary hypertension.

Gender, sex hormones and pulmonary hypertension.
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DOI:
10.4103/2045-8932.114756
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发表时间:
2013-04
影响因子:
2.6
通讯作者:
Oka M
Oka M
中科院分区:
医学4区
文献类型:
--
作者:
Austin ED;Lahm T;West J;Tofovic SP;Johansen AK;Maclean MR;Alzoubi A;Oka M

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大多数肺动脉高压(PAH)亚型的特点是女性更容易患病,尽管女性PAH患者在诊断后似乎活得更长。尽管“雌激素悖论”提高了女性的存活率,但增加了女性的易感性,这仍然是一个谜,但最近的进展已经开始揭示性激素的相互作用、肺动脉高压的发病机制和右心室对压力的反应。例如,在人体和实验模型中出现的新数据表明,雌激素或不同的性激素代谢可能改变易感受试者的疾病风险,雌激素可能与其他局部因素(如血清素)相互作用,以增强雌激素对肺血管系统的潜在破坏性慢性影响。无论如何,我们仍然不清楚为什么不是所有的雌激素化合物的作用都是一样的,也不清楚为什么雌激素在某些情况下具有保护作用,而在另一些情况下却有害。雄激素和其他化合物,如脱氢表雄酮,在发病机制和可能的治疗中的作用也必须考虑。在这篇综述中,我们将通过评估目前的人类、细胞和实验模型数据,讨论最近对雌激素、雌激素代谢、脱氢表雄酮和其他易感因素如何参与肺动脉高压的发病机制或潜在治疗的理解。
Most subtypes of pulmonary arterial hypertension (PAH) are characterized by a greater susceptibility to disease among females, although females with PAH appear to live longer after diagnosis. While this “estrogen paradoxȍ of enhanced female survival despite increased female susceptibility remains a mystery, recent progress has begun to shed light upon the interplay of sex hormones, the pathogenesis of pulmonary hypertension, and the right ventricular response to stress. For example, emerging data in humans and experimental models suggest that estrogens or differential sex hormone metabolism may modify disease risk among susceptible subjects, and that estrogens may interact with additional local factors such as serotonin to enhance the potentially damaging chronic effects of estrogens on the pulmonary vasculature. Regardless, it remains unclear why not all estrogenic compounds behave equally, nor why estrogens appear to be protective in certain settings but detrimental in others. The contribution of androgens and other compounds, such as dehydroepiandrosterone, to pathogenesis and possibly treatment must be considered as well. In this review, we will discuss the recent understandings on how estrogens, estrogen metabolism, dehydroepiandrosterone, and additional susceptibility factors may all contribute to the pathogenesis or potentially to the treatment of pulmonary hypertension, by evaluating current human, cell-based, and experimental model data.
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