生理学指标和无创心血管指标对急性高原反应的早期预警作用

李宗斌; 刘春伟; 郭军; 石亚君; 李泱; 王晋丽; 王晶; 陈韵岱

doi:10.24920/003552

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生理学指标和无创心血管指标对急性高原反应的早期预警作用

中国医学科学杂志（英文版） 2020年35卷第1期页码：13-19

Original Article | Updated：2024-04-10

- 生理学指标和无创心血管指标对急性高原反应的早期预警作用
- Affiliations：
  
  Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
- Author bio：
  
  * E-mail: cyundai@vip.163.com
- Funds：
  
  This study was supported by National Science and Technology Major Projects for Major New Drugs Innovation and Development(2014ZX09J14102-02A);Special Topic on Military Health Care(17bjz41);National Natural Science Foundation of China(81170249);National Natural Science Foundation of China(30700305)
- DOI：10.24920/003552
  中图分类号：
- 收稿日期：2019-04-29，
  
  网络出版日期：2020-03-31，
  
  纸质出版日期：2020-01-20
- Accepted：
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李宗斌, 刘春伟, 郭军, 等. 生理学指标和无创心血管指标对急性高原反应的早期预警作用[J]. 中国医学科学杂志（英文版）, 2020,35(1):13-19.

Li Zongbin, Liu Chunwei, Guo Jun, et al. Early Warning of Acute Altitude Sickness by Physiological Variables and Noninvasive Cardiovascular Indicators[J]. Chinese medical sciences journal, 2020, 35(1): 13-19.
李宗斌, 刘春伟, 郭军, 等. 生理学指标和无创心血管指标对急性高原反应的早期预警作用[J]. 中国医学科学杂志（英文版）, 2020,35(1):13-19. DOI： 10.24920/003552.

Li Zongbin, Liu Chunwei, Guo Jun, et al. Early Warning of Acute Altitude Sickness by Physiological Variables and Noninvasive Cardiovascular Indicators[J]. Chinese medical sciences journal, 2020, 35(1): 13-19. DOI： 10.24920/003552.

摘要

目的

探讨平原生理学指标和无创心血管指标的变化能否预测急进高原后急性高原反应的发生。

方法

招募106名汉族男性志愿者

分别在平原和急进高原后行24小时动态心电图、平板运动试验、心脏超声、血常规、血生化等检查。以Louise湖评分为因变量

进行多元回归分析

建立多元线性回归方程

以平原生理学指标和无创心血管指标预测急性高原反应发生的风险。

结果

急进高原后约49.05%的志愿者发生急性高原反应。与未发生急性高原反应的志愿者相比

发生急性高原反应的志愿者的部分平原指标的差异存在统计学意义

如三尖瓣环平面收缩偏移较低（22.0±2.66比23.2±3.19 mm

=1.998

=0.048）

嗜酸性粒细胞计数较高[(0.264±0.393)×10

/L比(0.126±0.084)×10

=-2.040

P=0.045]

相邻正常间隔数之间超过50 ms的差异百分比较高(PNN50

9.66%±5.40%比6.98%±5.66%

=-2.229

P=0.028)

心率变异三角指数较高（57.1±16.1比50.6±12.7

=-2.271

P=0.025）。急进高原后

发生急性高原反应的志愿者C反应蛋白偏高（0.098±0.103比0.062±0.045 g/L

=-2.132

=0.037）

天冬氨酸转氨酶偏高(19.7±6.72比17.3±3.95 U/L

=-2.231

=0.028)

肌酐偏高(85.1±12.9比77.7±11.2 mmol/L

=-3.162

=0.002)

碱性磷酸酶偏低（71.7±18.2比80.6±20.2 U/L

=2.389

=0.019）

全部窦性心搏RR间期的标准差偏低(126.5±35.9比143.3±36.4 ms

=2.320

=0.022)

心脏射血时间偏低(276.9±50.8比313.8±48.9 ms

=3.641

=0.001)

心率变异三角指数偏低(37.1±12.9比41.9±11.1

=2.020

=0.047)。以Louise湖评分为因变量

建立多元线性回归方程：路易斯湖得分=3.783+0.281×嗜酸性粒细胞计数-0.219×碱性磷酸酶+0.032×PNN50。

结论

本研究阐明了急进高原后生理学指标和无创心血管指标的差异

根据平原生理学指标和无创心血管指标建立了急进高原后急性高原反应预警方程。

Abstract

Objective

To examine if the variations at sea level would be able to predict subsequent susceptibility to acute altitude sickness in subjects upon a rapid ascent to high altitude.

Methods

One hundred and six Han nationality male individuals were recruited to this research. Dynamic electrocardiogram

treadmill exercise test

echocardiography

routine blood examination and biochemical analysis were performed when subjects at sea level and entering the plateau respectively. Then multiple regression analysis was performed to construct a multiple linear regression equation using the Lake Louise Score as dependent variable to predict the risk factors at sea level related to acute mountain sickness (AMS).

Results

Approximately 49.05% of the individuals developed AMS. The tricuspid annular plane systolic excursion (22.0±2.66

. 23.2±3.19 mm

=1.998

=0.048) was significantly lower in the AMS group at sea level

while count of eosinophil [(0.264±0.393)×10

. (0.126±0.084)×10

=-2.040

=0.045]

percentage of differences exceeding 50 ms between adjacent normal number of intervals (PNN50

9.66%±5.40%

. 6.98%±5.66%

=-2.229

=0.028) and heart rate variability triangle index (57.1±16.1

. 50.6±12.7

=-2.271

=0.025) were significantly higher. After acute exposure to high altitude

C-reactive protein (0.098±0.103

. 0.062±0.045 g/L

=-2.132

=0.037)

aspartate aminotransferase (19.7±6.72

. 17.3±3.95 U/L

=-2.231

=0.028) and creatinine (85.1±12.9

. 77.7±11.2 mmol/L

=-3.162

=0.002) were significantly higher in the AMS group

while alkaline phosphatase (71.7±18.2

. 80.6±20.2 U/L

=2.389

=0.019)

standard deviation of normal-to-normal RR intervals (126.5±35.9

. 143.3±36.4 ms

=2.320

=0.022)

ejection time (276.9±50.8

. 313.8±48.9 ms

=3.641

=0.001) and heart rate variability triangle index (37.1±12.9

. 41.9±11.1

=2.020

=0.047) were significantly lower. Using the Lake Louise Score as the dependent variable

prediction equation were established to estimate AMS: Lake Louise Score=3.783+0.281×eosinophil-0.219×alkaline phosphatase+0.032×PNN50.

Conclusions

We elucidated the differences of physiological variables as well as noninvasive cardiovascular indicators for subjects after high altitude exposure compared with those at sea level. We also created an acute high altitude reaction early warning equation based on the physiological variables and noninvasive cardiovascular indicators at sea level.

关键词

Keywords

references

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