急性高原反应发生相关的生理学指标研究

doi:10.24920/003518

摘要/Abstract

摘要： 目的探索与急性高原反应(acute mountain sickness, AMS)发生相关的生理学指标。方法 84名久居平原的青年男性志愿者,在40小时内进入到海拔4000米的高原地区。分别在平原及高原环境下对志愿者进行血液常规和生化实验室检查,脉氧饱和度检测,动态心电图以及动态血压等检查,记录相关生理学指标。到达目的海拔后,根据新版路易斯湖评分法对84名志愿者进行AMS评估。比较AMS阳性及AMS阴性两组志愿者的各项生理学指标,采用Logistic回归分析法分析与AMS发生相关的生理学特征。结果在84名急进高原的志愿者中,34名（40.5%）发生了AMS。对于发生AMS的志愿者,其在高原环境下的中性粒细胞百分比显著高于未发生AMS的志愿者(64.5%±11.2% vs. 58.1%±8.8%,P=0.014),而脉氧饱和度显著低于未发生AMS的志愿者(79.4%±5.4% vs. 82.7%±5.6%, P=0.008)。回归分析发现中性粒细胞比例（OR：1.06,95% CI：1.01 - 1.12,P=0.034)和脉氧饱和度(OR：0.87,95% CI：0.79 - 0.95,P=0.004)与AMS的发生显著相关。结论进入高原后机体维持血氧饱和度水平的能力,以及各种原因导致的中性粒细胞水平的升高与青年男性发生AMS相关。

关键词: 高原病, 低氧, 生理学

Abstract: Objective To identify the physiological variables associated with the development of acute mountain sickness (AMS).Methods Eighty four young Chinese men residing at low altitude were taken to an altitude of 4000 m within 40 hours. At sea level and at high altitude, we measured the heart rate, blood pressure, and peripheral oxygen saturation (SpO₂) respectively. We also collect blood samples from each participants before and after the altitude elevation. The blood routine and biochemical examinations were performed for all blood samples. The revised Lake Louise Criteria was adopted to diagnose AMS after the subjects arrived at the target high altitude. The association between the presence of AMS and subjects’ physiological variables were analysed statistically.Results Of 84 participants, 34 (40.5%) developed AMS. Compared with non AMS group, in the AMS group, the percentage of neutrophils was significantly higher (64.5%±11.2% vs. 58.1%±8.8%, P =0.014), while the level of SpO₂ was significantly lower (79.4%±5.4% vs. 82.7%±5.6, P=0.008). Binary logistic regression analyses emphasized the association of neutrophils (OR: 1.06, 95% CI: 1.01-1.12, P=0.034) and SpO₂ level (OR: 0.87, 95% CI : 0.79-0.95, P=0.004) with the development of AMS.Conclusion The ability to sustain SpO₂after altitude elevation and the increase of neutrophils were associated with the development of AMS in young males.

Key words: altitude sickness, hypoxia, physiology

基金资助: 国家科技重大专项项目重大新药创制基金(2014ZX09J1402-02A)

Liu Chunwei, Li Zongbin, Guo Jun, Shi Yajun, Wang Jinli, Chen Yundai. Physiological Variables Associated with the Development of Acute Mountain Sickness[J].Chinese Medical Sciences Journal, 2019, 34(4): 263-269.

图/表 5

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Variables	AMS(+) n=34	AMS(-) n=50	t/Z	P
Age(y)	25.0±1.9	25.6±2.4	-2.096	0.036^*
Weight(kg)	71.6±9.0	71.4±8.4	0.093	0.501†
Height(cm)	175.3±4.7	174.6±4.7	0.676	0.926†
BMI(kg/m²)	23.3±2.6	23.4±2.6	-0.561	0.575^*

Variables	AMS (+) n=34		AMS (-) n=50		t/Z^(a)	P†^(a)	t/Z^(b)	P†^(b)
Variables	Sea level	Altitude	Sea level	Altitude	t/Z^(a)	P†^(a)	t/Z^(b)	P†^(b)
RBC(10¹²/L)	5.3±0.4	5.3±0.3	5.2±0.4	5.2±0.4	1.349	0.181	1.987	0.050
Hb(g/L)	158.0±8.4	164.2±7.5	155.3±8.9	161.0±8.6	1.351	0.180	1.804	0.075
MCH(pg)	30.0±1.1	30.7±1.3	30.2±0.9	31.0±1.0	-0.616	0.539	-1.111	0.270
MCHC(g/L)	335.8±7.4	339.4±10.2	335.0±9.0	338.1±7.0	0.410	0.683	-1.537	0.124^*
MCV(fl)	89.5±3.2	90.4±2.9	90.1±2.6	91.6±3.0	-0.974	0.333	-1.275	0.202^*
WBC(10⁹/L)	7.2±1.8	8.7±2.5	6.5±1.7	8.1±1.7	1.653	0.102	1.169	0.248
Neutrophil (%)	54.5±8.4	64.5±11.2	52.8±6.9	58.1±8.8	0.969	0.335	-2.461	0.014^*
Monocyte (%)	5.5±1.2	3.9±1.0	6.0±1.3	4.9±1.3	-1.223	0.221^*	-3.521	<0.001^*
Basophil (%)	0.6±0.3	0.6±0.3	0.6±0.3	0.6±0.3	-0.010	0.992^*	-0.089	0.929^*
Lymphocyte (%)	36.5±7.5	29.3±10.5	38.3±6.6	34.9±8.1	-1.177	0.243	-2.699	0.008
Eosinophil (%)	2.9±3.6	1.6±1.4	2.8±4.3	1.5±1.2	-0.343	0.731^*	-0.247	0.805^*
Platelet(10⁹/L)	233.6±38.6	220.6±52.8	225.6±47.7	232.4±45.4	0.790	0.432	-1.081	0.283

Variables	AMS (+) n=34		AMS (-) n=50		t/Z^(a)	P†^(a)	t/Z^(b)	P†^(b)
Variables	Sea level	Altitude	Sea level	Altitude	t/Z^(a)	P†^(a)	t/Z^(b)	P†^(b)
ALT(U/L)	22.5±12.7	22.6±17.6	22.6±17.6	21.4±13.6	-1.678	0.093^*	-0.274	0.784^*
ALP(U/L)	69.4±12.8	73.6±19.0	68.0±20.4	77.3±20.6	-0.702	0.483^*	-0.980	0.327^*
TP(g/L)	75.6±3.3	78.3±3.9	75.4±3.2	77.5±4.2	0.345	0.731	0.839	0.404
ALB(g/L)	48.4±2.1	51.6±2.2	48.7±2.2	52.1±2.5	-0.635	0.527	-0.961	0.339
BUN( mmol/L)	4.6±1.2	5.0±0.8	4.7±1.0	5.0±1.0	-1.058	0.290^*	-0.584	0.559^*
Scr(μmol/L)	77.3±8.8	84.3±12.8	77.8±9.7	79.4±11.5	-0.244	0.808	1.833	0.071
Tc( mmol/L)	4.2±0.6	4.3±0.7	4.2±0.7	4.5±0.6	-0.002	0.999	0.598	0.119
HDL(mmol/L)	1.4±0.3	1.3±0.3	1.5±0.3	1.4±0.3	-1.421	0.159	-0.628	0.531
LDL(mmol/L)	2.6±0.6	2.5±0.7	2.6±0.7	2.7±0.6	-0.020	0.984	-0.912	0.364
TBil(μmol/L)	14.1±5.5	7.9±4.3	14.5±5.9	8.4±3.7	-0.105	0.917^*	-0.916	0.360^*
DBil(μmol/L)	4.8±2.0	3.1±1.8	4.9±1.6	3.2±1.0	-0.146	0.884	-1.615	0.106^*
cTnT(μg/L)	0.005±0.002	0.005±0.001	0.005±0.001	0.005±0.001	-1.445	0.148^*	-0.221	0.825^*
Na⁺(mmol/L)	141.6±1.5	143.3±2.0	142.0±2.0	143.6±1.9	-0.959	0.338^*	-1.482	0.138^*
Cl^-(mmol/L)	99.1±2.5	102.3±2.0	99.4±3.0	102.7±1.7	-0.531	0.597	-1.345	0.179^*

Variables	AMS (+) n=34		AMS (-) n=50		t/Z^(a)	P†^(a)	t/Z^(b)	P†^(b)
Variables	Sea level	Altitude	Sea level	Altitude	t/Z^(a)	P†^(a)	t/Z^(b)	P†^(b)
SpO₂(mmHg)	98.3±1.2	79.4±5.4	98.3±1.3	82.7±5.6	-0.074	0.941^*	-2.698	0.008
HR_max(/min)	130±10	134±12	132±14	133±16	-0.921	0.360	0.154	0.878
HR_min(/min)	48±5	53±7	48±5	52±7	0.166	0.869	0.894	0.374
HR_mean(/min)	72±6	82±8	73±8	81±10	-0.480	0.632	0.542	0.590
HRVTI	53.5±13.2	35.3±10.7	51.8±15.5	39.4±10.6	-0.869	0.385^*	-1.554	0.125
SBP_mean(mmHg)	113.5±6.4	119.6±8.3	114.7±6.7	119.5±8.1	-0.792	0.431	0.021	0.983
DBP_mean(mmHg)	69.1±5.9	75.4±7.1	69.9±5.6	74.4±6.8	-0.592	0.555	0.637	0.526
SCV(%)	15.7±5.9	15.6±5.3	15.4±6.7	16.6±6.0	-0.637	0.524^*	-0.803	0.424
DCV(%)	25.0±10.3	25.7±10.6	24.4±9.2	25.1±8.8	-0.195	0.845^*	-0.080	0.936^*

Variables	OR	95% CI	P
Age(y)	0.82	0.63-1.08	0.157
BMI(kg /m²)	0.91	0.74-1.12	0.376
Neutrophil (%)	1.06	1.01-1.12	0.034
SpO₂(mmHg)	0.87	0.79-0.95	0.004
Hb(g/L)	1.05	0.98-1.12	0.200
Scr(μmol/L)	1.02	0.97-1.06	0.459

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