支气管肺发育不良相关肺动脉高压的治疗策略进展与展望

Advances and Prospects in Therapeutic Strategies for Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension

摘要: 支气管肺发育不良(Bronchopulmonary Dysplasia, BPD)是早产儿，尤其极低出生体重儿常见的慢性呼吸系统疾病，而肺动脉高压(PH)是其严重且预后不良的并发症之一，显著增加了患儿死亡率及远期心肺与神经发育障碍等不良预后风险，已成为一个日益突出的临床问题。支气管肺发育不良相关性肺动脉高压(BPD-PH)是极早产儿严重的并发症，预后差，其治疗一直是临床面临的巨大挑战。近年来，BPD-PH的管理策略已从单一的支持治疗发展为包含急慢性期血管扩张剂靶向治疗、新型疗法探索在内的综合管理体系。此文系统综述BPD-PH治疗领域的最新进展，重点探讨吸入性一氧化氮(iNO)、5型磷酸二酯酶抑制剂(西地那非)、内皮素受体拮抗剂、前列环素类药物等靶向药物的应用现状与挑战，并展望干细胞疗法等新兴治疗策略的潜力。旨在为临床优化BPD-PH的个体化治疗方案提供参考。

Abstract: Bronchopulmonary Dysplasia (BPD) is a common chronic respiratory disease in preterm infants, particularly those with very low birth weight. Pulmonary Hypertension (PH) is one of its severe complications with a poor prognosis, significantly increasing the risks of mortality, long-term cardiopulmonary impairments, neurodevelopmental disorders, and other adverse outcomes. It has become an increasingly prominent clinical concern. Bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) is a severe complication in extremely preterm infants with a poor prognosis, and its treatment has always been a major clinical challenge. In recent years, the management strategy for BPD-PH has evolved from single supportive care to a comprehensive system including targeted therapy with vasodilators in acute and chronic phases, and exploration of novel therapies. This article systematically reviews the latest advances in the treatment of BPD-PH, focusing on the application status and challenges of targeted drugs such as inhaled nitric oxide (iNO), phosphodiesterase type 5 inhibitors (sildenafil), endothelin receptor antagonists, and prostacyclin analogs, and looks forward to the potential of emerging therapeutic strategies like stem cell therapy. The aim is to provide a reference for optimizing individualized treatment plans for BPD-PH in clinical practice.