慢性心源性肺疾病——一个崭新概念的提出

王金德 科主任 医学博士 主任医师 教授 硕士研究生导师

滨州医学院烟台附属医院呼吸内科

长期以来，对于慢性肺源性心脏病的认识，已经成为内科临床医生的基本共识，并且在经过多年充分的临床实践之后，在该病的基础和临床研究方面均取得重大进展。然而，在临床实践中，专业人员往往习惯于机械性地执行各类诊断标准，而忽视了对一些根本性问题的进一步思索和探讨。

本人从事内科(呼吸)临床多年以来，在关注慢性肺源性心脏病、慢性间质性肺疾病的同时，注意到这样一种现象，即许多慢性肺疾病往往合并存在慢性心脏疾患。尤其在老年患者，许多影像学上表现为所谓慢性间质性肺病，同时存在冠心病合并慢性舒张期心功能不全。风湿性心脏病二尖瓣病变合并左心房高压的患者，长期作用于肺血管可以引起肺循环高压。进而发现，合并肺部慢性间质性改变的也不在少数。

部分依据临床表现、胸部影像学诊断的所谓慢性阻塞性肺疾病患者，尤其老年患者，虽然存在肺部高调罗音及肺气肿征象，肺功能检查也存在一定程度的通气功能障碍，但缺乏明确的既往病史和高危因素，似乎不能完全用慢性阻塞性肺疾病加以解释，治疗上往往需要同时加用改善心肌供血、改善心功能等等措施方可奏效。当然，对于后一种情况，临床医生更乐意用所谓“肺心病合并冠心病”予以解释。

慢性肺血管疾病，尤其慢性肺血栓栓塞性疾病，在引起一系列心脏血液动力学改变的同时，经常引起肺脏通气、换气功能障碍。

基于上述观察，本人于近半年来首次在小范围提出了“慢性心源性肺疾病”这样一个崭新的概念。可以说，这样一个概念的提出既有顿悟式的灵感，更有多年临床实践的积累。可以认为是在关注和实践“慢性肺源性心脏病”基础上的心得，是相对于“慢性肺源性心脏病”的一个崭新名词。在提出这样一个新名词的同时，努力从临床上观察和收集病例，以努力求证这一现象。限于观察病例数尚少，只能初步提出这一概念，希望引起同道的重视和关注。期望经过大量的积累和探讨后，确认这样一个新的疾病类型。

二零一四年十一月一日

{Medical Correspondence}

Chronic Cardiogenic Pulmonary Disease (CCPD) – A Completely New Concept

Jinde Wang M.D.,

Chief physician of Yantai Yuhuangding Hospital, Yantai, Shandong Province, P. R. China.

Professor and Tutor of Medical School, Qingdao University, Shandong Province, P. R. China.

Professor and Tutor of Binzhou Medical College, Shandong Province, P. R. China.

E-mail: wjdmd_2000@sina.com

Blog: http://www.blog.sina.com.cn/alexanderwang001

Chronic Cor Pulmonale, a disease concerning the heart and the lungs, and a disease originating from the lungs, has been recognized as a sequential complication to the damaged parenchyma and pulmonary circulation. Its pathogenesis, pathophysiology, pathology, clinical manifestation, diagnosis, treatment, and even its prognosis are all familiar to clinical physicians. Particularly, vast progresses have been made in the domain of 'Chronic obstructive pulmonary disease (COPD)'.

However, when physicians diagnose such diseases, like COPD and interstitial lung disease (ILD), according to the guidance, they always do it in a mechanically routine way and ignore some fundamental problems beneath the origin. I myself have been practising respiratory medicine for nearly thirty years. During my practices in diagnosing chronic interstitial lung disease, I have noticed that some of the so-called 'interstitial lung diseases' in senior persons are essentially originated from eschemic coronary heart disease. and some patients diagnosed as 'COPD' are not really COPD. They did have a chronic history of dyspnea, cough with or without expectoration, but their lung function tests had not shown obstructive airway abnormalities. Otherwise, they usually had a past history of some kinds of chronic heart disease, like chronically persistent hypertension and eschemic coronary heart disease and so on. All these questions elicit from me an initial idea that there is and will be a completely new concept concerning the heart and the lungs. Maybe we can call it as 'chronic cardiogenic pulmonary disease (CCPD)', opposite to the old concept 'chronic obstructive pulmonary disease (COPD)' and 'chronic cor pulmonale'.

Therefore, I have formally presented this new concept on my blog in 11th Jun, 2009, in order to arouse a broad interest and lead to a hot discussion publically. I hope this completely new concept can be accepted worldwide in the circle of internal medicine and will be come into being as a 'product of thought' in the near future.