Expect pulmonary hypertension patients to "take fewer detours"

" pulmonary hypertension (PH) is not uncommon in clinical practice, but because its diagnosis involves multidisciplinary, easy to cause misdiagnosis, missed diagnosis, which also directly led to irregular treatment. In a recent interview with China Science Daily, Dr. Zhai Zhenguo, director of the Respiratory Center at the China-Japan Friendship Hospital, said the situation is expected to be solved.
Reason is that, on January 5, the Chinese Medical Journal published the Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension (2021 edition) by the Pulmonary Embolism and Pulmonary Vascular Disease Unit of the Respiratory Branch of the Chinese Medical Association, the Pulmonary Embolism and Pulmonary Vascular Disease Working Committee of the Respiratory Physicians Branch of the Chinese Physicians Association, etc.
we call for further strengthening multidisciplinary collaboration in the field of PH and comprehensively promoting the standardization of PH in China. Wang Chen, a member of the Chinese Academy of Engineering and one of the authors of the guide, said.。 PH refers to the clinical and pathophysiological syndrome caused by a variety of heterogeneic diseases (eganology) and different pathogenesis, which causes changes in pulmonary vascular structure and function, which cause elevated pulmonary vascular resistance and pulmonary arterial pressure, and then develops into right heart failure and even death. Its clinical symptoms are fatigue, breathing difficulties, chest tightness, chest pain and fainting.
Xiong Changming, one of the main curators of the guidelines and director of the Pulmonary Vascular Disease Center at the Chinese Academy of Medical Sciences, told reporters that PH is clinically divided into five broad categories, including pulmonary hypertension (PAH), LEFT heart disease PH, respiratory disease and/or HY due to hypoxia, chronic thrombosis pulmonary artery hypertension (CTEPH) and/or pulmonary blockage lesions caused by PH and/or multiple factors.
, there is very little literature on PH epidemiology worldwide. In the UK, the prevalence of PH is 97 per million, with a female/male ratio of 1.8:1. Epidemiological data on PAH in a number of international registration studies show that the incidence of PAH in adults is about 2.4 per million years and the prevalence rate is about 15 per million.
" as a large population, although china does not have epidemiological data for PH, but it is certain that a large number of potential PH patients have not been diagnosed and treated in a timely manner. Zhai Zhenguo said.
Since the 1970s, experts and scholars represented by Cheng Hsiensheng, founder of the field of pulmonary hypertension in China and professor of pulmonary vascular disease diagnosis and treatment center of the Chinese Academy of Medical Sciences, have carried out hypoxic PH and other pulmonary vascular disease-related studies with pulmonary heart disease as the core, and have made a series of progress. However, due to the lack of effective drugs to treat PH at that time, clinicians did not pay enough attention to it.
inflection point in 2006. This year PAH-targeted drugs Poroshentin and Ilo prostatin entered our country, PH diagnosis and treatment situation gradually improved. From the government, health administration departments to academic organizations, experts and scholars have paid attention to PH, there are paH-targeted drugs for clinical, domestic targeted drugs approved ...
. However, the public awareness of PH is still not high, many clinicians even stay at the level of 30 years ago, still think that PH, especially PAH prognoste is very poor, no cure. Xiong Changming said that the domestic pulmonary vascular disease diagnosis and treatment centers are mainly concentrated in several large cities, and the relative lack of professionals engaged in PH, more lack of standardized, professionally certified PH centers, so PH patients usually need to transfer multiple departments, multiple places to be finally diagnosed.
and even after diagnosis, the treatment and follow-up management of PH patients is not optimistic. For example, without a right heart catheterization and acute vascular reaction, vascular active drugs are used at will, and treatment is carried out in accordance with PAH without adequate examination and evaluation.In view of this, based on the current evidence-based medical evidence, experts in respiratory and critical medicine, cardiovascular medicine, rheumatology, imaging, basic medicine, evidence-based medicine and other fields worked together to complete the above guidelines over a period of 3 years.
Told reporters that for the first time, the guidelines combine the format and presentation of European and American guidelines with China's clinical reality, and propose PH diagnosis and treatment processes that are in line with Chinese physicians' clinical practice. At the same time, pay attention to the follow-up and management of PH patients, and according to the basic state of patients before treatment and clinical indicators after short-term treatment to judge the condition and assess the prognostic, and adjust the treatment plan. In addition, the guidelines also propose the establishment of professional PH centers to improve the PH patient referral system.
also worth mentioning that the guide lists each recommendation separately, marks the GRADE rating symbol, uses the words "recommendation" and "recommended" and interprets it for the reader to read and use. At the same time, the main evidence and sources of recommendations are summarized.as mentioned in the
guidelines, the pathogenesis of PH is complex and is the result of a combination of factors and links, including external causes (low oxygen, tobacco, dust, other physical and chemical biological factors, etc.), internal causes (genetics, development, structure, disease, etc.) and interaction factors (micro-ecological, infection, immunity, drugs, etc.).
At the same time, the guidelines recommend 12 diagnostic tests, including electroenculation, chest X-rays, pulmonary function and arterial blood gas analysis, genetic testing, etc., and recommend the diagnosis of PH from four aspects: diagnosis (clinical and ultrasound cardiographic screening), diagnosis (hemodynamic diagnosis), seeking cause (emoticon diagnosis) and functional evaluation (severity assessment).
, the guidelines list children's PH separately and emphasize that right heart catheter testing (RHC) is the gold standard for children's PH diagnosis." Today, a good time for PH patients, new screening methods have improved the level of early identification, diagnosis and identification of PH-related causes, innovative drug research and development for PAH is still on the rise, PH early intervention and effective targeted drug therapy It is expected to prevent or reverse the progression of the disease, and the application of surgical procedures (such as pulmonary transplantation or pulmonary thrombosis) or interventional techniques (e.g., cystic pulmonary artery forming) has led to a complete cure of part of PAH or CTEPH, with significant improvements in the patient's prognosis. Zhai Zhenguo said.
and the construction of the PH Center remains critical. "It not only improves patient outcomes and prognostics, but also saves costs." Zhai Zhenguo said that PH is a progressive disease, once the patient's condition worsens, transferred to the PH center, often can receive better comprehensive treatment.
For example, ph centers in Europe and the United States require a multidisciplinary team of experts, equipped with specialized wards and outpatient clinics and related examinations and drugs, and have cooperative networks, education and training, etc., but also require that the annual number of PH cases not less than 200 cases, annual follow-up PAH or CTEPH patients not less than 5 cases, the average monthly addition of PAH or CTEPH patients not less than 5 cases, with RHC testing technology and acute vascular reaction test cases.
" these experiences are worthy of our reference, but China's PH patient base is large, the geographical distribution of medical resources is more different, so the establishment of China's PH center standards also need to be combined with national conditions. Zhai Zhenguo said that multidisciplinary coordination to promote the construction of China's PH standardized diagnosis and treatment system, is an important task at present.
, Wang Chen hopes that in the next 10 years, China's PH research and treatment to reach the international advanced level, and strive to achieve China's Health China Action 2030 vision. (Source: Zhang Siwei, China Science Journal)
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