高原红细胞增多症患者红细胞二磷酸甘油酸和氧亲和力变化的探讨  

CHANGES OF RED CELL 2,3-DIPHOSPHOGLYCERATE AND OXYGEN AFFINITY OF BLOOD IN SUBJECTS WITH HIGH ALTITUDE POLYCYTHEMIA

作　　者：格日力[1] 佘海茹 陈秋红[1] 和伦高娃 吴天一[1] 小林俊夫 久保惠嗣 竹罔ぃち 子 

机构地区：[1]青海省高原医学科学研究所,日本信州大学医学部第一内科

出　　处：《中国应用生理学杂志》1995年第3期205-208,共4页Chinese Journal of Applied Physiology

摘　　要：在海拔４３００ｍ地区，对１８名移居汉族、２４名世居藏族和２１名高原红细胞增多症（ＨＡＰＣ）患者测定了２，３—二磷酸甘油酸（２，３—ＤＰＧ）和肺通气功能，并进行了血气分析。结果显示：ＨＡＰＣ患者的全血和红细胞内２，３—ＤＰ６浓度均显著高于健康组，但世居、移居健康组之间无明显差异。ＨＡＰＣ组的红细胞２，３—ＤＰＧ和Ｐｄｏ＿２呈显著负相关（ｒ＝—０．７７１，Ｐ＜０．０１），而在健康组无显著相关（ｒ＝—０．２６，Ｐ＞０．０５）。ＨＡＰＣ组与健康组相比，ｐＨ、Ｐａｏ＿２和Ｓａｏ＿２降低，Ｐａｃｏ＿２和肺泡动脉氧分压差增高。ＨＡＰＣ病人Ｐ＿（５０）为３．７５±０．６６ｋＰａ，健康组为３．４０±０．１２ｋＰａ（Ｐ＜０．０５），Ｐ＿（５０）与２，３－ＤＰＧ呈正相关（ｒ＝０．５９２，Ｐ＜０．０５）。ＨＡＰＣ组最大呼气中段流量和５０％肺活量最大呼气量明显低于健康组（Ｐ＜０．０１）。本研究提示：①ＨＡＰＣ患者的低氧血症可能与血中２，３－ＤＰＧ浓度过高有关；②轻度肺功能异常亦可促使红细胞进一步增多。diphosphoglycerate(2,3-DPG)in both whole blood and erythrocytes, pulmonary venti-lation,and arterial blood gas were measured in 18 Han newcomers(normal Han group),24Tibetan natives and 21 subjects with high-altitude polycythemia(HAPC) at an altitude of4300m. Tbe results showed that the red cell 2,3-DPG(2,3-DPG/RBC)in the HAPC and nor-mal Han group was 5.13±0.82 and 4.0±0.53 mmol/L(P< 0.01),respectively,and there wasno significant difference in 2,3-DPG/RBC between Tibetans and Hans.There was negative cor-relation between 2,3-DPG / RBC and Pao_2 in the HAPC group(r=-0.77 1,P<0.01),but notin the normal Han group(r=-0.263,P>0.05).The HAPC group, compared with the normalgroup,showed higher Paco_2 and alvolar-arterial Po_2 difference, and lower pH and Pao_2.P_(50)(Po_2 when Sao_2=50%) in the HAPC and normal Han groups was 3.75 ± 0.66 and 3.40 ± 0. 12kPa(P<0.05),respectively. There was positive correlation between P_(50) and 2,3-DPG / RBC insubjects with HAPC(r=0.592,P<0.05).The mean values for maximal midexpiratory flow(MMEF) and flow at 50% of forced vital capacity(V_(50))in the HAPC group were significantlylower than those in the normal control group.These results suggest that(1) abnormal hypoxemiain subjects with HAPC is at least partly due to an overproduction of 2,3-DPG;(2)the abnormali-ty of lung function is probably an important factor for development of excessive polycythemia athigh altitude.

关 键 词：二磷酸甘油酸 红细胞增多症 氧亲和力 高山病 

分 类 号：R594.302[医药卫生—内科学]