Kronik obstrüktif akciğer hastalığı ve pulmoner hipertansiyon

Pulmoner hipertansiyon, kronik obstrüktif akciğer hastalığının (KOAH) sık görülen bir komplikasyonudur. KOAH?a bağlı olarak gelişen pulmoner hipertansiyon genellikle hafif-orta derecededir. Buna karşılık, şiddetli KOAH?lı hastaların %5-10?unda ciddi pulmoner hipertansiyon görülebilmektedir. KOAH?lı hastaların küçük bir bölümünde, ortalama pulmoner arter basıncının >35-40 mmHg olması şeklinde tanımlanan ?orantısız? pulmoner hipertansiyon ve belirgin dispne ile yorgunluğu açıklayamayan nispeten korunmuş akciğer fonksiyonu vardır. KOAH?lı hastalarda pulmoner hipertansiyon kötü prognoz ile ilişkilidir. KOAH?taki pulmoner hipertansiyonun nedeni genellikle hipoksik pulmoner vazokonstrüksiyon olarak görülmektedir. Son yıllarda, KOAH?ta pulmoner hipertansiyonun sellüler ve moleküler patofizyolojisi konusuna duyulan ilgi artmıştır. En çarpıcı bulgular vasküler endotelyal hücreler ve bu hücrelerden salınan endojen mediatörlerdir. KOAH?ta vasküler yeniden yapılanma (remodelling) pulmoner arter basıncındaki artışın başlıca nedenidir. Günümüzde KOAH?ta pulmoner hipertansiyon için spesifik ve etkili bir tedavi yoktur. Etkili tedavide uzun süreli oksijen tedavisine başlama zamanı önemlidir. KOAH?lı hastalarda pulmoner hipertansiyonun etkili tedavisi için terapötik ajanlar üzerinde yapılacak araştırmalara hâlâ ihtiyaç vardır. Bu derlemede, KOAH?taki pulmoner hipertansiyonun patofizyolojisi ve tedavisi konuları güncel bilgiler ışığında yeniden gözden geçirilmektedir.

Chronic obstructive pulmonary disease and pulmonary hypertension

Pulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD). The increase in pulmonary artery pressure (PAP) is often mild to moderate. However, 5-10! of patients with advanced COPD may suffer from severe pulmonary hypertension. A small proportion of COPD patients may present with ??out-of-proportion"" PH, defined by a mean PAP >35-40 mmHg and a relatively preserved lung function that can not explain prominent dyspnea and fatigue. In patients with of COPD, PH is associated with bad prognosis. The cause of pulmonary hypertension in COPD is generally assumed to be hypoxic pulmonary vasoconstriction. Recently, interest in the cellular and molecular aspects of the pathophysiology of PH in COPD has increased. The most striking finding is the role of vascular endothelial cells and endogenous mediators released by these cells. Pulmonary vascular remodelling in COPD is the main cause of increase in pulmonary artery pressure. At the present, there is no specific and effective treatment for this condition in COPD. The timing of initiation of long-term oxygen therapy is important for the effective management of PH in COPD. Research on therapeutic agents for the effective treatment of PH is still needed in the management aspect of patients with COPD. This review focuses on the recent advances in our understanding of the pathophysiology and treatment of PH in COPD.

Kaynakça

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