青藏高原高原肺水肿的临床特征及实验室与影像学特点

李宗斌; 陈洪艳; 李佳月; 李高原; 刘春伟; 陈韵岱

doi:10.24920/11813

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青藏高原高原肺水肿的临床特征及实验室与影像学特点

Chinese Medical Sciences Journal 2018年33卷第3期页码：160-173

研究论文 | Updated：2024-04-10

- 青藏高原高原肺水肿的临床特征及实验室与影像学特点
- Affiliations：
  
  1 Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
  2 Department of Pulmonary and Cardiology, Chinese PLA 22 Hospital, Geermu, Qinghai 816000, China
- Author bio：
  
  * Tel: 86-10-55499009, Fax: 86-10-55499009, E-mail: cyundai@vip.163.com
- Funds：
  
  Supported by the National Science and Technology Major Projects for Major New Drugs Innovation and Development(2014ZX09J14102-02A(2014.1-2016.12))
- DOI：10.24920/11813
  中图分类号：
- 网络出版日期：2018-09-20，
  
  纸质出版日期：2018-09-20
- Accepted：
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李宗斌, 陈洪艳, 李佳月, 等. 青藏高原高原肺水肿的临床特征及实验室与影像学特点[J]. Chinese Medical Sciences Journal, 2018,33(3):160-173.

Li Zongbin, Chen Hongyan, Li Jiayue, et al. Clinical, Laboratory and Imaging Features of High Altitude Pulmonary Edema in Tibetan Plateau[J]. Chinese medical sciences journal, 2018, 33(3): 160-173.
李宗斌, 陈洪艳, 李佳月, 等. 青藏高原高原肺水肿的临床特征及实验室与影像学特点[J]. Chinese Medical Sciences Journal, 2018,33(3):160-173. DOI： 10.24920/11813.

Li Zongbin, Chen Hongyan, Li Jiayue, et al. Clinical, Laboratory and Imaging Features of High Altitude Pulmonary Edema in Tibetan Plateau[J]. Chinese medical sciences journal, 2018, 33(3): 160-173. DOI： 10.24920/11813.

摘要

目的

分析中国人高原肺水肿的临床特征及实验室与影像学特点。

方法

本研究对98例高原肺水肿患者进行了回顾性分析

通过阅读病历、统计分析

总结了高原肺水肿患者住院时及出院前的临床特征、实验室及影像学特点。

结果

48例患者(49.0%)在海拔2800米至3000米发生高原肺水肿

95例患者 (96.9%)是男性。湿罗音分布在两肺

14例患者右肺的湿罗音强度强于左肺。入院时

患者的白细胞计数[（12.83±5.55)×109/L比(8.95±3.23)×109/L

P=0.001）]及中性粒细胞计数[（11.34±3.81)×109/L比(7.49±2.83)×109/L

P=0.001）]

显著高于出院时

而白细胞的其他类型计数显著低于出院时。入院时的血清碱性磷酸酶（115.8±37.6 mmol/L比85.7±32.4 mmol/L

P=0.020）

胆碱酯酶（7226.2± 1631.8 mmol/L比6285.3±1693.3 mmol/L

P=0.041）

肌酐（401.9±114.2 mmol/L比75.1±12.8 mmol/L

P=0.021）

尿酸（85.2±17.1 mmol/L比326.0±154.3

P=0.041）

以及尿糖浓度（7.20±1.10 mmol/L比5.51±1.11 mmol/L

P=0.001）显著高于出院时。入院时的二氧化碳结合力（26.7±4.42 mmol/L比28.9±4.50 mmol/L

P=0.042）及血清钙（2.32±0.13比2.41±0.10 mmol/L

P=0.006）显著低于出院时。入院时血气分析表现为低氧血症合并呼吸性碱中毒。

结论

男性更容易发生高原肺水肿

发生高原肺水肿时右肺损伤较左肺为重。高原肺水肿发生时部分血常规、血生化、血气分析结果发生变化。

Abstract

Objective

To analyze characteristics of high altitude pulmonary edema (HAPE) in Chinese patients.

Methods

We performed a retrospective study of 98 patients with HAPE. We reviewed the medical records and summarized the clinical

laboratory and imaging characteristics of these cases

and compared the results on admission with those determined before discharge.

Results

Forty-eight (49.0%) patients developed HAPE at the altitude of 2800 m to 3000 m. Ninty-five (96.9%) patients were man. Moist rales were audible from the both lungs

and moist rales over the right lung were clearer than those over the left lung in fourteen patients. The white blood cells [(12.83±5.55)

versus

(8.95±3.23) ×10

=0.001)] as well as neutrophil counts [(11.34±3.81)

versus

(7.49±2.83)×10

=0.001)] were higher

whereas the counts of other subsets of white blood cells were lower on admission than those after recovery (all

0.05). Serum levels of alkaline phosphatase (115.8±37.6

versus

85.7±32.4 mmol/L

=0.020)

cholinesterase (7226.2±1631.8

versus

6285.3±1693.3 mmol/L

=0.040)

creatinine (85.2±17.1

versus

75.1±12.8 mmol/L

=0.021)

uric acid (401.9±114.2

versus

326.0±154.3 mmol/L

=0.041)

and uric glucose (7.20±1.10

versus

5.51±1.11 mmol/L

=0.001) were higher

but carbondioxide combining power (CO

26.7±4.4

versus

28.9±4.5 mmol/L

=0.042) and serous calcium (2.32±0.13

versus

2.41±0.10 mmol/L

=0.006) were lower on admission. Arterial blood gas results showed hypoxemia and respiratory alkalosis on admission.

Conclusions

In the present research

men were more susceptible to HAPE than women

and in the process of HAPE

the lesions of the right lung were more serious than those of the left lung. Some indicators of routine blood test and blood biochemistry of HAPE patients changed.

关键词

Keywords

references

Bärtsch P , Swenson ER . Clinical practice: acute high-altitude illnesses . N Engl J Med 2013 ; 368 ( 24 ): 2294 - 302 . doi: 10.1056/NEJMcp1214870 10.1056/NEJMcp1214870 . DOI: 10.1056/NEJMcp1214870 http://doi.org/10.1056/NEJMcp1214870 http://www.nejm.org/doi/10.1056/NEJMcp1214870 http://www.nejm.org/doi/10.1056/NEJMcp1214870

Richalet JP , Letournel M , Souberbielle JC . Effects of high-altitude hypoxia on the hormonal response to hypothalamic factors . Am J Physiol Regul Integr Comp Physiol 2010 ; 299 ( 6 ): R1685 - 92 . doi: 10.1152/ajpregu.00484.2010 10.1152/ajpregu.00484.2010 . DOI: 10.1152/ajpregu.00484.2010 http://doi.org/10.1152/ajpregu.00484.2010 http://www.physiology.org/doi/10.1152/ajpregu.00484.2010 http://www.physiology.org/doi/10.1152/ajpregu.00484.2010

Gabry AL , Ledoux X , Mozziconacci M . High-altitude pulmonary edema at moderate altitude (<2,400 m; 7,870 feet): a series of 52 patients . Chest 2003 ; 123 ( 1 ): 49 - 53 . doi: 10.1378/chest.123.1.49 10.1378/chest.123.1.49 . DOI: 10.1378/chest.123.1.49 http://doi.org/10.1378/chest.123.1.49 http://linkinghub.elsevier.com/retrieve/pii/S0012369216343744 http://linkinghub.elsevier.com/retrieve/pii/S0012369216343744

Sophocles AM Jr . High-altitude pulmonary edema in Vail, Colorado, 1975-1982 . West J Med 1986 ; 144 ( 5 ): 569 - 73 . DOI: 10.1620/tjem.149.105 http://doi.org/10.1620/tjem.149.105 http://www.ncbi.nlm.nih.gov/pubmed/3716417 http://www.ncbi.nlm.nih.gov/pubmed/3716417

Chitra L , Boopathy R . Adaptability to hypobaric hypoxia is facilitated through mitochondrial bioenergetics: an in vivo study . Br J Pharmacol 2013 ; 169 ( 5 ): 1035 - 47 . doi: 10.1111/bph.12179 10.1111/bph.12179 . DOI: 10.1111/bph.12179 http://doi.org/10.1111/bph.12179 http://doi.wiley.com/10.1111/bph.12179 http://doi.wiley.com/10.1111/bph.12179

Villena JA , Kralli A . ERRα: a metabolic function for the oldest orphan . Trends Endocrinol Metab 2008 ; 19 ( 8 ): 269 - 76 . doi: 10.1016/j.tem.2008.07.005 10.1016/j.tem.2008.07.005 . DOI: 10.1016/j.tem.2008.07.005 http://doi.org/10.1016/j.tem.2008.07.005 http://linkinghub.elsevier.com/retrieve/pii/S1043276008001173 http://linkinghub.elsevier.com/retrieve/pii/S1043276008001173

Magalhães J , Ascensão A , Soares JM , et al . Acute and severe hypobaric hypoxia increases oxidative stress and impairs mitochondrial function in mouse skeletal muscle . J Appl Physiol 2005 ; 99 ( 4 ): 1247 - 53 . doi: 10.1152/japplphysiol.01324.2004 10.1152/japplphysiol.01324.2004 . DOI: 10.1152/japplphysiol.01324.2004 http://doi.org/10.1152/japplphysiol.01324.2004 http://www.physiology.org/doi/10.1152/japplphysiol.01324.2004 http://www.physiology.org/doi/10.1152/japplphysiol.01324.2004

Wilckens T . Glucocorticoids and immune function: physiological relevance and pathogenic potential of hormonal dysfunction . Trends Pharmacol Sci 1995 ; 16 ( 6 ): 193 - 7 . doi: 10.1016/S0165-6147(00)89021-5 10.1016/S0165-6147(00)89021-5 . DOI: 10.1016/S0165-6147(00)89021-5 http://doi.org/10.1016/S0165-6147(00)89021-5 http://linkinghub.elsevier.com/retrieve/pii/S0165614700890215 http://linkinghub.elsevier.com/retrieve/pii/S0165614700890215

Jeklova E , Leva L , Jaglic Z , et al . Dexamethasone-induced immunosuppression: a rabbit model . Vet Immunol Immunopathol 2008 ; 122 ( 3-4 ): 231 - 40 . doi: 10.1016/j.vetimm.2007.11.011 10.1016/j.vetimm.2007.11.011 . DOI: 10.1016/j.vetimm.2007.11.011 http://doi.org/10.1016/j.vetimm.2007.11.011 http://linkinghub.elsevier.com/retrieve/pii/S0165242707004205 http://linkinghub.elsevier.com/retrieve/pii/S0165242707004205

Richalet JP , Souberbielle JC , Antezana AM , et al . Control of erythropoiesis in humans during prolonged exposure to the altitude of 6,542 m . Am J Physiol 1994 ; 266 ( 3 Pt 2 ): R756 - 64 . doi: 10.1152/ajpregu.1994.266.3.R756 10.1152/ajpregu.1994.266.3.R756 . DOI: 10.1111/j.1748-1716.1994.tb09697.x http://doi.org/10.1111/j.1748-1716.1994.tb09697.x http://www.europepmc.org/abstract/MED/8160868 http://www.europepmc.org/abstract/MED/8160868

Lundby C , Thomsen JJ , Boushel R , et al . Erythropoietin treatment elevates haemoglobin concentration by increasing red cell volume and depressing plasma volume . J Physiol 2007 ; 578 ( Pt 1 ): 309 - 14 . doi: 10.1113/jphysiol.2006.122689 10.1113/jphysiol.2006.122689 . DOI: 10.1113/jphysiol.2006.122689 http://doi.org/10.1113/jphysiol.2006.122689 http://doi.wiley.com/10.1113/jphysiol.2006.122689 http://doi.wiley.com/10.1113/jphysiol.2006.122689

Heinicke K , Prommer N , Cajigal J , et al . Long-term exposure to intermittent hypoxia results in increased hemoglobin mass, reduced plasma volume, and elevated erythropoietin plasma levels in man . Eur J Appl Physiol 2003 ; 88 ( 6 ): 535 - 43 . doi: 10.1007/s00421-002-0732-z 10.1007/s00421-002-0732-z . DOI: 10.1007/s00421-002-0732-z http://doi.org/10.1007/s00421-002-0732-z http://link.springer.com/10.1007/s00421-002-0732-z http://link.springer.com/10.1007/s00421-002-0732-z

Park Y , Schoene N , Harris W . Mean platelet volume as an indicator of platelet activation: methodological issues . Platelets 2002 ; 13 ( 5-6 ): 301 - 6 . doi: 10.1080/095371002220148332 10.1080/095371002220148332 . DOI: 10.1080/095371002220148332 http://doi.org/10.1080/095371002220148332 http://www.tandfonline.com/doi/full/10.1080/095371002220148332 http://www.tandfonline.com/doi/full/10.1080/095371002220148332

Imoberdorf R , Garlick PJ , McNurlan MA , et al . Enhanced synthesis of albumin and fibrinogen at high altitude . J Appl Physiol 2001 ; 90 ( 2 ): 528 - 37 . doi: 10.1152/jappl.2001.90.2.528 10.1152/jappl.2001.90.2.528 . DOI: 10.1055/s-2001-11346 http://doi.org/10.1055/s-2001-11346 http://www.physiology.org/doi/10.1152/jappl.2001.90.2.528 http://www.physiology.org/doi/10.1152/jappl.2001.90.2.528

Miura G , Kato K , Shimizu T , et al . Heme oxygenase-1 (HO-1) is constitutively up-regulated in top alpinists . Biochem Biophys Res Commun 2012 ; 417 ( 1 ): 104 - 8 . doi: 10.1016/j.bbrc.2011.11.064 10.1016/j.bbrc.2011.11.064 . DOI: 10.1016/j.bbrc.2011.11.064 http://doi.org/10.1016/j.bbrc.2011.11.064 http://linkinghub.elsevier.com/retrieve/pii/S0006291X1102078X http://linkinghub.elsevier.com/retrieve/pii/S0006291X1102078X

Glantzounis GK , Tsimoyiannis EC , Kappas AM , et al . Uric acid and oxidative stress . Curr Pharm Des 2005 ; 11 ( 32 ): 4145 - 51 . doi: 10.2174/138161205774913255 10.2174/138161205774913255 . DOI: 10.2174/138161205774913255 http://doi.org/10.2174/138161205774913255 <![CDATA[http://www.eurekaselect.com/openurl/content.php?genre=article&issn=1381-6128&volume=11&issue=32&spage=4145]]> <![CDATA[http://www.eurekaselect.com/openurl/content.php?genre=article&issn=1381-6128&volume=11&issue=32&spage=4145]]>

Sinha S , Singh SN , Ray US . Total antioxidant status at high altitude in lowlanders and native highlanders: role of uric acid . High Alt Med Biol 2009 ; 10 ( 3 ): 269 - 74 . doi: 10.1089/ham.2008.1082 10.1089/ham.2008.1082 . DOI: 10.1089/ham.2008.1082 http://doi.org/10.1089/ham.2008.1082 http://www.liebertpub.com/doi/10.1089/ham.2008.1082 http://www.liebertpub.com/doi/10.1089/ham.2008.1082

Luo Y , Zhu J , Gao Y . Metabolomic analysis of the plasma of patients with high-altitude pulmonary edema (HAPE) using 1H NMR . Mol Biosyst 2012 ; 8 ( 6 ): 1783 - 8 . doi: 10.1039/C2MB25044F 10.1039/C2MB25044F . DOI: 10.1039/c2mb25044f http://doi.org/10.1039/c2mb25044f http://xlink.rsc.org/?DOI=c2mb25044f http://xlink.rsc.org/?DOI=c2mb25044f

Woolcott OO , Ader M , Bergman RN . Glucose homeostasis during short-term and prolonged exposure to high altitudes . Endocr Rev 2015 ; 36 ( 2 ): 149 - 73 . doi: 10.1210/er.2014-1063 10.1210/er.2014-1063 . DOI: 10.1210/er.2014-1063 http://doi.org/10.1210/er.2014-1063 https://academic.oup.com/edrv/article-lookup/doi/10.1210/er.2014-1063 https://academic.oup.com/edrv/article-lookup/doi/10.1210/er.2014-1063

Bailey DM , Kleger GR , Holzgraefe M , et al . Pathophysiological significance of peroxidative stress, neuronal damage, and membrane permeability in acute mountain sickness . J Appl Physiol 2004 ; 96 ( 4 ): 1459 - 63 . doi: 10.1152/japplphysiol.00704.2003 10.1152/japplphysiol.00704.2003 . DOI: 10.1152/japplphysiol.00704.2003 http://doi.org/10.1152/japplphysiol.00704.2003 http://www.physiology.org/doi/10.1152/japplphysiol.00704.2003 http://www.physiology.org/doi/10.1152/japplphysiol.00704.2003

Woods DR , Stacey M , Hill N , et al . Endocrine aspects of high altitude acclimatization and acute mountain sickness . J R Army Med Corps 2011 ; 157 ( 1 ): 33 - 7 . doi: 10.1136/jramc-157-01-06 10.1136/jramc-157-01-06 . DOI: 10.1136/jramc-157-01-06 http://doi.org/10.1136/jramc-157-01-06 http://jramc.bmj.com/lookup/doi/10.1136/jramc-157-01-06 http://jramc.bmj.com/lookup/doi/10.1136/jramc-157-01-06

Ge RL , Babb TG , Sivieri M , et al . Urine acid-base compensation at simulated moderate altitude . High Alt Med Biol 2006 ; 7 ( 1 ): 64 - 71 . doi: 10.1089/ham.2006.7.64-71 10.1089/ham.2006.7.64-71 . DOI: 10.1039/b514050c http://doi.org/10.1039/b514050c http://www.liebertpub.com/doi/10.1089/ham.2006.7.64 http://www.liebertpub.com/doi/10.1089/ham.2006.7.64

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