炎症识别与控制课件.ppt
湖南省人民医院呼吸内科 胡 瑞 成微信号:hrc13723886638 Email:,炎症识别与控制：肺动脉高压干预的新靶点？,1 PH 的定义与分类2 PH炎症机制概述3 炎症在PH发病中的作用炎症与PAH的关系炎症与HPH的关系炎症与OSAS并发PH的关系炎症与CETPH的关系,内容提纲,2013-02-27 法国尼斯 第五届世界肺动脉高压大会,Gali N,et al.2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension.Eur Respir J.2015;46(4):903-975.,PH is defined as an increase in mean pulmonary arterial pressure(PAPm)25 mmHg at rest as assessed by right heart catheterization(RHC).Available data have shown that the normal PAPm at rest is 14 3 mmHg with an upper limit of normal of approximately 20 mmHg.The clinical significance of a PAPm between 21 and 24 mmHg is unclear.,1.1 PH 定义,1 PH的定义与分类,1.2 PH分类,Gali N,et al.Eur Respir J.2015;46(4):903-975.,1 PH的定义与分类,1.2 PH分类,1 PH的定义与分类,Tuder RM,et al.Exuberant endothelial cell growth and elements of inflammation are present in plexiform lesions of pulmonary hypertension.Am J Pathol.1994;144(2):275-85.科罗拉多大学健康科学中心病理系 7/10例PAH Voelkel NF,Tuder R.Interleukin-1 receptor antagonist inhibits pulmonary hypertension induced by inflammation.Ann NY Acad Sci.1994;725:104-9.Humbert M,et al.Increased interleukin-1 and interleukin-6 serum concentrations in severe primary pulmonary hypertension.Am J Respir Crit Care Med.1995;151:162831.,2.1 早期研究始于PAH,2 PH炎症机制概述,Wilkins MR.Eur Respir Rev:2012;21:123,1926,2 PH炎症机制概述,2.2 涉及多种类型PH,perivascular macrophages(CD68+)macrophages/monocytes(CD14+)Mast cells dendritic cells(CD209+)T cells(CD3+)cytotoxic T cells(CD8+)helper T cells(CD4+)FoxP3(+)(T regulatory cells),2.3 炎症细胞,Tuder RM,et al.J Am Coll Cardiol.2013;62(25 Suppl):D4-12.,2 PH炎症机制概述,IL-1 IL-18 IL-6 IL-8 IL-10 IL-13 MCP-1 CRPTNF-TGF-ICAM-1 VCAM-1 SDF-1/CXCR4,2.4 相关炎症因子,Tuder RM,et al.J Am Coll Cardiol.2013;62(25 Suppl):D4-12.,2 PH炎症机制概述,Groth A,et al.Respir Res.2014;15:47.,血管外膜炎症细胞募集启动炎症反应向中膜和内膜发展影响平滑肌和内皮功能引起血管重构,2.5 过程特点,Tuder RM,et al.J Am Coll Cardiol.2013;62(25 Suppl):D4-12.,由外及里,2 PH炎症机制概述,Rameh V,et al.Biomark Insights.2016;11:85-9.,IL-6:correlated with low survival TNF-:correlated with low survivalTGF-:correlated with low survival,2.6 炎症标志物与 PH 风险评估,2 PH炎症机制概述,3.1 各类PH的发病机制,Wilkins MR.Eur Respir Rev:2012;21:123,1926,3 炎症在PH发病中的作用,Aggarwal S,et al.Compr Physiol.2013;3(3):1011-34.,3 炎症在PH发病中的作用,3 炎症在PH发病中的作用,Ranchoux B,et al.Int J Mol Sci.2016;17(6).,3 炎症在PH发病中的作用,Ranchoux B,et al.Int J Mol Sci.2016;17(6).,4.1 PAH发病机制,Sharma S,et al.Pulm Circ.2016;6(3):261-73.,4 炎症与PAH的关系,4.2 PAH炎症细胞,Rabinovitch M,et al.Circ Res.2014;115(1):165-75.,4 炎症与PAH的关系,4.3 PAH主要炎症标志物,Awad KS,et al.Pulm Circ.2016;6(3):285-94.,4 炎症与PAH的关系,4.4 炎症在PAH血管重构中的作用,Rabinovitch M,et al.Circ Res.2014;115(1):165-75.,4 炎症与PAH的关系,El Chami H,et al.Prog Cardiovasc Dis.2012;55(2):218-28.,4 炎症与PAH的关系,4.4 炎症在PAH血管重构中的作用,4.5 LDL对PAH炎症的影响,Sharma S,et al.Pulm Circ.2016;6(3):261-73.,4 炎症与PAH的关系,Martin YN,et al.Am J Physiol Heart Circ Physiol.2014;306(9):H1253-64.,4 炎症与PAH的关系,4.6 性别对PAH炎症的影响,5.1 HPH机制二次打击学说,Pugliese SC,et al.Am J Physiol Lung Cell Mol Physiol.2015;308(3):L229-52.,5 炎症与HPH的关系,Pugliese SC,et al.Am J Physiol Lung Cell Mol Physiol.2015;308(3):L229-52.,5 炎症与HPH的关系,5.2 炎症机制启动缺氧性血管重塑,Pugliese SC,et al.Am J Physiol Lung Cell Mol Physiol.2015;308(3):L229-52.,5 炎症与HPH的关系,5.3 缺氧性血管重塑的细胞机制,Kholdani C，et al.Pulm Circ.2015;5(2):220-7,6 炎症与OSAS并发PH的关系,6 炎症与OSAS并发PH的关系,7 炎症与CTEPH的关系,CTEPH患者血浆和血栓中 CRP、TNF-、MCP-1增高，与血流动力学参数相关。,Lang I M，et al.Eur Respir J.2013;41:462468.,炎症是PH的重要机制之一炎症标志物在PH诊断方面缺乏特异性炎症标志物对PH预后判断具有参考价值炎症机制干预正在走向PH的临床管理炎症管理将成为PH预防和治疗的发展方向,小结与展望,谢谢分享！,
