肥胖时代的肺动脉高压：肺动脉高压表型的导航

文献信息

中文摘要

引言： 肺动脉高压（PAH）是一种进行性血管病变，其表型在过去几十年中已从年轻女性转变为伴有心血管代谢合并症的老年患者。肥胖是这些合并症中最常见且临床后果最严重的一种，在当代PAH登记中影响24-40%的患者。
涵盖领域： 我们综述肥胖的流行病学及其对PAH的影响；肥胖的定义及体重指数的局限性；肥胖对脂肪、心血管和呼吸系统的影响；其与健康差异的关联；对肥胖且疑似肺动脉高压（PH）患者的临床处理方法，包括右心导管检查及激发试验和食管测压；合并症与肥胖悖论；以及管理，包括减重、PAH特异性治疗、射血分数保留的心力衰竭和睡眠呼吸障碍。对PubMed/MEDLINE数据库自建库至2026年9月发表的文献进行了检索。
专家意见： 肥胖对PH的起源、症状、诊断和管理均有影响。肥胖患者PH的准确表征首先取决于测量和报告反映真实跨壁血流动力学的压力。基于肠促胰岛素的治疗和激活素信号抑制是有前景的治疗方向，但需要在肥胖和肺动脉高压患者中开展专门试验。

英文摘要

INTRODUCTION: Pulmonary arterial hypertension (PAH) is a progressive vasculopathy whose phenotype has shifted over the decades from young women to older patients with cardiometabolic comorbidities. Obesity is among the most prevalent and clinically consequential of these comorbidities, affecting 24-40% of patients in contemporary PAH registries.
AREAS COVERED: We review the epidemiology of obesity and its impact on PAH; the definition of obesity and the limitations of body mass index; the effects of obesity on adipose, cardiovascular and respiratory systems; its association with health disparities; the clinical approach to the patient with obesity and suspected pulmonary hypertension (PH), including right heart catheterization with provocative maneuvers and esophageal manometry; comorbid conditions and the obesity paradox; and management, including weight loss, PAH-specific therapy, heart failure with preserved ejection fraction and sleep-disordered breathing. A literature search of PubMed/MEDLINE was performed for articles published from database inception to September 2026.
EXPERT OPINION: Obesity has implications in the origin, symptoms, diagnosis and management of PH. Accurate characterization of PH in obese patients depends first on measuring and reporting pressures that reflect true transmural hemodynamics. Incretin-based therapy and activin signaling inhibition are promising therapeutic directions, but dedicated trials in patients with obesity and pulmonary hypertension are needed.