胡瑞成炎症识别与控制.ppt

Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,2016-07-25,1,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,2,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,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,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 CRP,TNF-,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 survival,TGF-,:,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！,