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CIT 2019 - 研究亮点 - 肺动脉高压 & Cpc-PH

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2015年ESC肺动脉高压指南是对2009年ESC/欧洲呼吸病学会(ERS)肺动脉高压治疗指南的再版更新:

1. 肺动脉高压定义为静息状态下经右心导管评估的平均肺动脉压(PAPm)≥25 mmHg。

2. 基于静息状态下的肺动脉压力即可确诊,运动试验不作为诊断依据,只用来评估功能性严重程度。

3. 由于缺乏相关证据,新版指南取消了“运动性肺动脉高压”和“不成比例性肺动脉高压”的诊断。

4. 新版指南对肺动脉高压进行了详细分类,其中,1型肺动脉高压和4型慢性血栓栓塞性肺动脉高压(CTEPH)需要特殊治疗。


2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT)



由陈绍良教授研发的肺动脉高压去神经术(Pulmonary Artery Denervation ,PADN)即是解决对药物治疗不敏感的毛细血管后及毛细血管前肺动脉高压(combined post-capillary and pre-capillary PH, Cpc-PH)的介入手段。


左室或左房充盈压增高,继而肺静脉压升高,导致被动性或毛细血管前性肺动脉高压(Ipc-PH),其肺血管阻力(PVR)及肺动脉舒张压差(DPG)正常。部分患者会出现肺血管重构,导致混合型毛细血管前和后肺动脉高压(Cpc-PH),定义为PVR>3 WUs 和(或)DPG ≥ 7mmHg,并进一步增加肺动脉压及右室后负荷,最终导致心室-肺血管之间的不匹配。尽管肺动脉压升高是左心衰竭预后差的预测因子,但是肺动脉高压靶向药物治疗左心相关的肺动脉高压(PH-LHD)的临床试验多为阴性或中性结果,因此目前指南推荐PH-LHD的治疗仍以治疗原发左心疾病为主。既往研究证实心衰及肺动脉高压时交感神经过度激活,导致肺动脉收缩加剧,是发生CPC-PH的主要机制之一。陈绍良教授率先提出的肺动脉去神经术(PADN)通过显著损伤肺动脉交感神经治疗肺动脉高压。PADN-1研究首次证实PADN增加特发性肺动脉高压患者的活动耐量并改善血流动力学参数。本团队既往一项注册研究亦证实PADN在小样本PH-LHD患者中的安全性及有效性。


PADN-1 Study - “Pulmonary artery denervation to treat pulmonary arterial hypertension: the single-center, prospective, first-in-man PADN-1 study (first-in-man pulmonary artery denervation for treatment of pulmonary artery hypertension)”



PADN-5 Study - “Pulmonary Artery Denervation Significantly Increases 6-minute Walk Distance for Patients with Combined Pre- and Post-capillary Pulmonary Hypertension Associated with the Left Heart Failure: PADN-5 Study


Pericardial effusion is correlated with clinical outcome after pulmonary artery denervation for pulmonary arterial hypertension