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Advances in Pulmonary Hypertension

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关键词: Psychosocial Issues;    Lifestyle Issues;    Social Work;    WHO Group 1- Pulmonary Arterial Hypertension;    vasculogenesis;    vascular remodeling;    endothelial dysfunction;    angiogenesis;    Endothelial progenitor cells;    Micro Particles;    Classification;   

DOI  :  

学科分类：医学（综合）

来源: Pulmonary Hypertension Association

【 摘 要 】

We know from clinical experience with patients undergoing pneumonectomy for lung cancer that reducing the pulmonary vascular bed by 50% does not result in overt pulmonary hypertension. However, most patients with PAH have a much greater reduction in perfused pulmonary microvasculature. By the time a patient with PAH arrives at the PH clinic in WHO functional class 3, their functional microvascular surface area may be decreased to 20-25% of normal.1 This reduction is due to obstruction and flow restriction in small precapillary arterioles, and the therapeutic challenge that PAH clinicians face is to somehow regain some of the lost vascular bed. Our current therapies may offer some benefit in that direction, although the direct evidence for this is lacking. Strategies to deal with the excess cellular proliferation seen in PAH might include trying to encourage cellular apoptosis, trying to re-seed the bed with healthier cells, or trying to induce a local environment within the microvasculature that would support healthy cells and select against the abnormal cells. Strategies that utilize all these approaches may ultimately prove to be the most successful.

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