References

systhiper

Системные гипертензии

Systemic Hypertension

2075-082X2542-2189

LLC «ИнтерМедсервис»

systhiper-20

Research Article

ПУЛЬМОНОЛОГИЯ

Легочная гипертензия при хронической обструктивной болезни легких

Авдеев

С. Н.

noemail@neicon.ru

НИИ пульмонологии Минздрава РФ, МоскваRussian Federation

2004

23122022

1511

2022

Авдеев С.Н.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.syst-hypertension.ru/jour/article/view/20

Хроническая обструктивная болезнь легких (ХОБЛ) является одной из ведущих причин заболеваемости и смертности во всем мире. ХОБЛ определяют как заболевание, характеризующееся ограничением воздушного потока, которое не полностью обратимо; ограничение воздушного потока обычно прогрессирует и связано с патологическим воспалительным ответом дыхательных путей на повреждающие частицы или газы . Легочная гипертензия (ЛГ) и ее прямое следствие – хроническое легочное сердце – являются наиболее частыми и прогностически неблагоприятными осложнениями ХОБЛ.Медикаментозная терапия при вторичных ЛГ должна быть направлена прежде всего на терапию основного заболевания, т.е. в данном случае у больных ХОБЛ необходимо использовать в полном объеме все средства для максимального улучшения бронхиальной проходимости, контроля за воспалением дыхательных путей и оптимизации показателей газообмена.В течение последних лет появились несколько перспективных препаратов, эффективность которых уже доказана у больных с первичной ЛГ. К числу таких препаратов относятся аналоги простациклина (илопрост, трепростенил, беропрост), антагонисты рецепторов эндотелина (бозентан).С учетом значительного повышения у больных ХОБЛ уровня эндотелина в крови, существуют теоретические предпосылки для использования антагонистов рецепторов эндотелина при ЛГ у данных больных.

References1

Global Initiative for Chronic Obstructive Lung Diseases (GOLD). Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO workshop report. Publication Number 2701, April 2001; 1–100.

Weitzenblum E, Hirth C, Ducolone A et al. Prognostic value of pulmonary artery pressure in chronic obstructive pulmonary disease. Thorax 1981; 36: 752–8.

Zielinski J, Mac Nee W, Wedzicha J et al. Causes of death in patients with COPD and chronic respiratory failure. Monaldi Arch Chest Dis 1997; 52: 43–7.

Hida W, Tun Y, Kikuchi Y et al. Pulmonary hypertension in patients with chronic obstructive pulmonary disease: recent advances in pathophysiology and management. Respiration 2002; 7: 3–13.

Weitzenblum Е, Demedts M. Treatment of pulmonary hypertension in chronic obstructive pulmonary disease. Eur Respir Mon 1998,7: 180–8.

World Health Organization. Chronic cor pulmonale: a report of the expert committee. Circulation 1963; 27: 594–8.

Fishman A.P. State of the art: chronic cor pulmonale. Am Rev Respir Dis 1976; 114: 775–94.

Weitzenblum E. Chronic cor pulmonale. Heart 2003; 89: 225–30.

Burrows B, Kettel L.J, Niden A.H et al. Patterns of cardiovascular dysfunction in chronic obstructive lung disease. N Engl J Med 1972; 286: 912–8.

Scharf S.M, Iqbal M, Keller C et al. Hemodynamic characterization of patients with severe emphysema. Am J Respir Crit Care Med 2002; 166: 314–22.

Burrows B, Fletcher C.M, Heard B.E et al. Clinical types of chronic obstructive lung disease in London and in Chicago: a study of 100 patients. Am Rev Respir Dis 1964; 90: 14–27.

Harris P, Heath D. Normal variations in pressure and flow. In: Harris P, Heath D, eds. The Human Pulmonary Circulation. 3rd ed. Edinburgh: Churchill Livingstone 1986; 149–60.

Von Euler U, Lijestrand G. Observations on the pulmonary arterial blood pressure in cat. Acta Physiol Scand 1946; 12: 301–20.

Weitzenblum E, Sautegeau A, Ehrrhart M et al. Long - term course of pulmonary arterial pressure in patients with chronic obstructive pulmonary disease Am Rev Respir Rev 1984; 130: 993–8.

Bergofsky E.H, Holzman S. A study of the mechanisms involved in the pulmonary arterial pressor response to hypoxia. Circ Res 1967; 20: 506–19.

Mac Nee W. Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease, Part One. Am J Respir Crit Care Med 1994; 150: 833–52 and 1158–68.

Dinh-Xuan A.T, Higenbottam T, Clelland C et al. Impairment of endothelium - dependent pulmonary artery relaxation in chronic obstructive pulmonary disease. N Engl J Med 1991; 324: 1539–47.

Le Cras T.D, Mc Murtry I.F. Nitric oxide production in the hypoxic lung. Am J Physiol 2001; 280: L575–L58.

Zieche R, Petkov V, Williams J et al. Lipopolysaccharide and interleukin 1 augment the effects of hypoxia and inflammation in chronic obstructive pulmonary disease. Proc Natl Acad Sci USA 1996; 93: 12478–83.

Cherniaev A, Samsonova M, Avdeev S, Bazarov D. Pulmonary vascular remodeling in COPD versus bronchial asthma. Eur Respir J 2003; 22 (Suppl. 45): 82s.

Barbera J.A, Peinado V.I, Santos S. Pulmonary hypertension in chronic obstructive pulmonary disease. Eur Resp J 2003; 21: 892–905.

Fessler H.E. Heart - lung interactions: applications in the critically ill. Eur Respir J 1997; 10: 226–37.

Nakamura A, Kasamatsu N, Hashizume I et al. Effects of hemoglobin on pulmonary arterial pressure and pulmonary vascular resistance in patients with chronic emphysema. Respiration 2000; 67: 502–6.

Defouilloy C, Teiger E, Sediame S et al. Polycythemia impairs vasodilator response to acetylcholine in patients with chronic hypoxemic lung disease. Am J Respir Crit Care Med 1998; 157: 1452–60.

Weitzenblum Е, Chaouat А. Hypoxic pulmonary hypertension in man: what minimum daily duration of hypoxaemia is required? Eur Respir J 2001; 18: 251–3.

Lee-Chiong T.L, Matthay R.A. The heart in the stable COPD patient. In: Similowski T, Whitelaw W.A, Derenne J.P, eds. Clinical Management of Chronic Obstructive Pulmonary Disease. New York: Marcel Dekker. 2002; 475–532.

Baudouin S.V. Oedema and cor pulmonale revisited. Thorax 1997; 52: 401–2.

Hill N.S. The cardiac exam in lung disease. Clin Chest Med 1987; 8: 273–85.

Matthay R.A, Schwarz M.I, Ellis J.H et al. Pulmonary artery hypertension in chronic obstructive pulmonary disease: determination by chest radiography. Invest Radiol 1981; 16: 95–100.

Incalzi R.A, Fuso L, De Rosa M, et al. Electrocardiographic signs of chronic cor pulmonale: A negative prognostic finding in chronic obstructive pulmonary disease. Circulation 1999; 99: 1600–5.

Klinger J.R, Hill N.S. Right ventricular dysfunction in chronic obstructive pulmonary disease: evaluation and management. Chest 1991; 99: 715–23.

Naeije R, Tobricki A. More on the noninvasive diagnosis of pulmonary hypertension: Doppler echocardiography revisited. Eur Respir J 1995; 8: 1445–9.

Matthay R.A, Berger H.J. Noninvasive assessment of right and left ventricular function in acute and chronic respiratory failure. Crit Care Med 1983; 11: 329–38.

Jardin F, Dubourg O, Bourdarias J.P. Echocardiographic pattern of acute cor pulmonale. Chest 1997; 111: 209–17.

Louie E.K, Rich S, Levitsky S, Brundage B.H. Doppler echocardiographic demonstration of the differential effects of right ventricular pressure and volume overload on left ventricular geometry and filling. J Am Coll Cardiol 1992; 19: 84–90.

Kitabatake A, Inoue M, Asao M et al. Noninvasive evaluation of pulmonary hypertension by a pulsed doppler technique. Circulation 1983; 68: 302–9.

Burghuber O.C, Brunner C.H, Scherk P, Weissel M. Pulsed Doppler echocardiography to assess pulmonary artery hypertension in chronic obstructive pulmonary disease. Monaldi Arch Chest Dis 1993; 48: 121–5.

Burgess M.I, Mogulkoc N, Bright-Thomas R.J et al. Comparison of echocardiographic markers of right ventricular function in determining prognosis in chronic pulmonary disease. J Am Soc Echocardiogr 2002; 15: 633–9.

Yock P.G, Popp R.L. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation 1984; 70: 657–62.

Tramarin R, Torbicki A, Marchandise B et al. Doppler echocardiographic evaluation of pulmonary artery pressure in chronic obstructive pulmonary disease. Eur Heart J 1991; 12: 103–11.

Higham M.A, Dawson D, Joshi J et al. Utility of echocardiography in assessment of pulmonary hypertension secondary to COPD. Eur Respir J 2001; 17: 350–5.

Kirshir B, Himelman R.B, Schiller M.B. Non - invasive estimation of right atrial pressure estimation from inspiratory collapse of the inferior vena cava. Am J Cardiol 1990; 16: 493–6.

Thorens J.B, Ritz M, Reynard C et al. Hemodynamic and endocrinological effects of noninvasive mechanical ventilation in respiratory failure. Eur Respir J 1997; 10: 2553–9.

Kruger S, Haage P, Hoffmann R et al. Diagnosis of pulmonary arterial hypertension and pulmonary embolism with magnetic resonance angiography. Chest 2001; 120: 1556–61.

Saito H, Dambara T, Aiba M et al. Evaluation of cor pulmonale on a modified short - axis section of heart by magnetic resonance imaging. Am Rev Respir Dis 1992; 146: 1576–81.

Gayed I, Boccalandro F, Fang B, Podoloff D. New method for calculating right ventricular ejection fraction using gated myocardial perfusion studies. Clin Nucl Med 2002; 27: 334–8.

Brent B.N, Berger H.J, Matthay R.A et al. Physiologic correlates of right ventricular ejection fraction in chronic obstructive pulmonary disease: a combined radionuclide and hemodynamic study. Am J Cardiol 1982; 50: 255–62.

Chemla D, Castelain V, Herve P et al. Haemodynamic evaluation of pulmonary hypertension. Eur Respir J 2002; 20: 1314–31.

Raeside D.A, Brown A, Patel K.R et al. Ambulatory pulmonary artery pressure monitoring during sleep and exercise in normal individuals and patients with COPD. Thorax 2002; 57: 1050–3.

American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995; 152: S77–S120.

Wiedemann, H.P, Matthay, R.A. Cor pulmonale in chronic obstructive pulmonary disease: circulatory pathophysiology and management. Clin Chest Med 1990; 11: 523–39.

Muramoto A, Caldwell J, Albert R.K et al. Nifedipine dilates the pulmonary vasculature without producing symptomatic systemic hypotension in upright resting and exercising patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease. Am Rev Respir Dis 1985; 132: 963–6.

Agust_ A.G.N, Barber_ J.A, Roca J et al. Hypoxic pulmonary vasconstriction and gas exchange during exercise in chronic obstructive pulmonary disease. Chest 1990; 97: 268–75.

Agostoni P, Doria E, Galli C et al. Nifedipine reduces pulmonary pressure and vascular tone during short - but not long - term treatment of pulmonary hypertension in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1989; 139: 120–5.

Konietzko N, Schlehe H, Harich B, Matthys H. Effect of isosorbide dinitrate on hemodynamics and respiration of patients with coronary artery disease and of patients with chronic cor pulmonale. Respiration 1975; 32: 368–77.

Федорова Т.А. Хроническое легочное сердце. В книге: "Хронические обструктивные болезни легких" под ред. Чучалина А.Г. М.: ЗАО "Издательство БИНОМ", Спб: "Невский Диалект", 1998; С. 192–215.

Zielinsky J, Hawrylkiewicz I, Goreika D et al. Сaptopril effects on pulmonary and systemic hemodynamics in chronic cor pulmonale. Chest 1986; 90: 562–5.

Kanazawa H, Okamoto T, Hirata K et al. Deletion polymorphism in the angiotensin converting enzyme gene are associated with pulmonary hypertension evoked by exercise challenge in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 162: 1235–8.

Kanazawa H, Hirata K, Yoshikawa J Effects of captopril administration on pulmonary haemodynamics and tissue oxygenation during exercise in ACE gene subtypes in patients with COPD: a preliminary study. Thorax 2003; 58: 629–31.

Mathur P.N, Powles A.C.P, Pugsley S.O et al. Effect of digoxin on right ventricular function in severe chronic airflow obstruction. Ann Intern Med 1981; 95: 283–8.

Polic S, Rumboldt Z, Dujic Z et al. Role of digoxin in right ventricular failure due to chronic cor pulmonale. Int J Clin Pharmacol Res 1990; 10: 153–62.

Salvaterra C.G, Rubin L.J. Investigation and management of pulmonary hypertension in obstructive pulmonary disease. Am Rev Respir Dis 1993; 148: 1414–7.

Borst M.M, Leschke M, Konig U, Worth H. Repetitive hemodilution in chronic obstructive pulmonary disease and pulmonary hypertension: effects on pulmonary hemodynamics, gas exchange, and exercise capacity. Respiration 1999; 66: 225–32.

Crockett A.J, Moss J.R, Cranston J.M, Alpers J.H. Domicilary oxygen for COPD (Cochrane Review). In: The Cochrane Library, Issue 41, 2003. Oxford: Update Software.

Neff A.L, Petty T.A. Long - term continuous oxygen therapy in chronic airway obstruction: mortality in relation to cor pulmonale, hypoxia and hypercapnia. Ann Intern Med 1970; 72: 621–6.

Medical Research Council Working Party. Long - term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Lancet 1981; i: 681–6.

Nocturnal Oxygen Therapy Trial Group: Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Ann Intern Med 1980; 93: 391–8.

Weitzenblum E, Oswald M, Apprill M et al. Evoluation of physiological variables in patients with chronic obstructive pulmonary disease before and during long - term oxygen therapy. Respiration 1991; 58: 126–31.

Buyse B, Demedts M. Long - term oxygen treatment with concentrators and liquid oxygens. Acta Clin Belg 1995; 50: 149–57.

Goldstein R.S, Ramcharan V, Bowes G, Mc Nicholas W.T, Bradley D, Phillipson E.A. Effect of supplemental nocturnal oxygen on gas exchange in patients with severe obstructive lung disease. N Engl J Med 1984; 310: 425–9.

Georgopoulos D, Rossi A, Moxham J. Ventilatory support in COPD. Eur Respir Monogr 1998; 7: 185–208.

Schonhofer B, Barchfeld T, Wenzel M, Kohler D. Long - term effects of non - invasive mechanical ventilation on pulmonary haemodynamics in patients with chronic respiratory failure. Thorax 2001; 56: 524–8.

Singh S, Evans T.W. Nitric oxide, the biological of the decade: fact or fiction? Eur Respir J 1997; 10: 699–707.

Adatia I, Wessel D.L. Therapeutic use of inchaled nitric oxide. Curr Opin Pediatr 1994; 6: 583–90.

Pepke-Zaba J, Morrell N.W. Pulmonary hypertension in patients with COPD: NO treatment? Thorax 2003; 58: 289–93.

Siddons T.E, Asif M, Higenbottam T.W. Therapeutic role of nitric oxide in respiratory disease. Medscape 2000; 4 (2), Inc.

Germann P, Ziescher R, Leitner C et al. Addition of nitric oxide to oxygen improves cardiopulmonary function in patients with severe COPD. Chest 1998; 114: 29–35.

Moinard J, Manier G, Pillet O et al. Effect of inhaled nitric oxide on hemodynamics and V/Q inequalities in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1994; 149: 1482–7.

Avdeev S.N, Tsareva N.A, Nekludova G.V, Chuchalin A.G. Inhaled nitric oxide in patients with acute cor pulmonale due to acute exacerbation of chronic obstructive pulmonary disease. Eur Respir J 2003; 22 (Suppl.45): 269s.

Gibbons G.H: Endothelial function as a determinant of vascular function and structure: A new therapeutic target. Am J Cardiol 1997; 79: 3–8.

Yoshida M, Taguchi O, Gabazza E.C et al. Combined inhalation of nitric oxide and oxygen in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1997; 155: 526–9.

Vonbank K, Ziesche R, Higenbottam T.W et al. Controlled prospective randomised trial on the effects on pulmonary haemodynamics of the ambulatory long term use of nitric oxide and oxygen in patients with severe COPD. Thorax 2003; 58: 289–93.

Geddes D, Davies M, Koyama H et al. Effect of lung - volume – reduction surgery in patients with severe emphysema. N Engl J Med 2000; 343: 239–45.

Mineo T.C, Pompeo E, Rogliani P et al. for the Pulmonary Emphysema Research Group. Effect of lung volume reduction surgery for severe emphysema on right ventricular function. Am J Respir Crit Care Med 2002; 165: 489–94.

Galie N, Manes A, Branzi A. The new clinical trials on pharmacological treatment in pulmonary arterial hypertension. Eur Respir J 2002; 20: 1037–49.

Olschewski H, Ghofrani H.A, Walmrath D et al. Inhaled prostacyclin and iloprost in severe pulmonary hypertension secondary to lung fibrosis. Am J Respir Crit Care Med 1999; 160: 600–7.

Roland M, Bhowmik A, Sapsford R.J et al. Sputum and plasma endothelin-1 levels in exacerbations of chronic obstructive pulmonary disease. Thorax 2001; 56: 30–5.

Kessler R, Faller M, Fourgaut G et al. Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999; 159: 158–64.

The authors declare that there are no conflicts of interest present.