人体在高海拔低氧并重体力劳动时急性高原反应与肺动脉压的关系及其返回低海拔后的变化  

Relationship between acute high altitude reaction and pulmonary arterial pressure in high altitude combined strong physical work in human body and its change after return to lower altitude

作　　者：杨生岳[1] 冯恩志[1] 闫自强[1] 贺巍[1] 田忠新[1] 殷和[1] 马力夫[1] 周其全[2] 石自福 

机构地区：[1]解放军第四医院兰州军区呼吸内科中心 [2]第三军医大学高原军事医学系 [3]解放军68303部队医院

出　　处：《中华肺部疾病杂志（电子版）》2010年第2期12-15,共4页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：国家科技支撑计划项目(2009BAI85B003)

摘　　要：目的观察部队官兵在高海拔低氧并重体力劳动时急性高原反应（acute high altitude reaction,AHAR）与肺动脉压（pulmonary arterial pressure,PAP）的关系及其返回低海拔后的变化。方法选择低海拔（1500m）快速进入高海拔（3700m）并从事重体力劳动的男性官兵96名,年龄18~35岁。根据AHAR症状评分,分为重度AHAR组（A组,n=24）、轻中度AHAR组（B组,n=47）和无AHAR组（C组,n=25）,在该高度逗留50d后下撤前及返回低海拔（1500m）后12h、15d测定平均肺动脉压（mean pulmonary arterialpressure,mPAP）、血浆内皮素-1（endothelin-1,ET-1）、一氧化氮（nitric oxide,NO）,并与低海拔（1500m）50名健康官兵（D组）比较。结果 A组mPAP和血浆ET-1[分别为（34.70±2.94）mm Hg、（68.07±5.33）ng.L-1]显著高于B组[分别为（28.42±1.32）mm Hg、（55.58±2.91）ng.L-1]、C组[分别为（24.23±1.56）mm Hg、（47.27±2.63）ng.L-1]和D组[分别为（18.50±1.30）mm Hg、（33.23±2.86）ng.L-1],（均P〈0.01）,血浆NO（53.76±4.03）μmol.L-1显著低于B组（65.54±2.97）μmol.L-1、C组（72.92±3.20）μmol.L-1和D组（82.43±4.03）μmol.L-1,（均P〈0.01）,B组与C组之间、C组与D组之间亦有显著性差异（均P〈0.01）。海拔3700m AHAR总计分与mPAP、血浆ET-1呈显著正相关（分别r=0.672、0.712,均P〈0.01）,与血浆NO显著负相关（r=-0.619,P〈0.01）;mPAP与血浆ET-1显著正相关（r=0.712,P〈0.01）,与血浆NO显著负相关（r=-0.686,P〈0.01）。海拔3700mPAP和血浆ET-1显著高于海拔1500m12h、15d和D组（均P〈0.01）,血浆NO显著低于海拔1500m12h、15d和D组,（均P〈0.01）,海拔1500m12h与15d之间有显著性差异（均P〈0.01）,15d与D组之间差异无显著性（均P〉0.05）。结论人体在高海拔低氧并重体力时AHAR越重,PAP越高,ET-1与NO比值失衡可能是低氧性肺动脉高压发生发展的重要原因之一。返回低海拔后12h有显著改善,15d恢复到正常水平。Objective To assess the relationship between acute high altitude reaction （AHAR） and pulmonary arterial pressure（PAP） in high altitude combined strong physical work in human body and its change after return to lower altitude. Methods Ninety-six officers and soldiers of rapid into high altitude（3 700 m）combined strong physical work were analyzed, all subjects were male ,aged 18-35 years. According to the symptomatic scores of AHAR were divided into 3 groups： severe AHAR （ group A, n = 24）, mild to moderate AHAR （ group B, n = 47 ） and without AHAR （ group C,n =25）. Mean PAP（ mPAP）, levels in plasma endothelin-1 （ ET-1 ） and nitric oxide（NO） were measured at the altitude stayed after 50 d , return to lower altitude（ 1 500 m）12 h and 15 d later,and 50 healthy volunteers（ group D）at 1 500 m altitude served as controll. Results Level of mPAP and plasma ET-1 [ （ 34.70± 2.94 ）mm Hg, （ 68.07± 5.33 ） ng·L-1 were significantly higher in group A than those in groupB[（28.42±1.32）mmHg,（55.58±2.91）ng·L-1] , in group C [（24.23±1.56） mm Hg, （47.27 ± 2.63 ）ng·L-1 ] and in group D [ （ 18.50 ± 1.30） mm Hg, （ 33.23± 2.86 ） ng·L-1 ） ], （ all P 〈 0.01 ）, and plasma NO [ （ 53.76 ± 4.03 ） μmol·L-1 was significantly lower in group A than those in group B [ 65.54 ±2.97 ）μmol·L-1 ], group C [ （ 72.92 ± 3.20 ） μmol·L-1 ] and in group D [ （ 82.43 ± 4.03 ）μmol·L-1 ] , （ all P 〈 0.01 ）, there were significan differences between which in group B and group C, group C and group D（ all P 〈0.01 ）. Altitude 3 700 m 50 d, AHAR total scores was positively correlated with mPAP and ET-1 （r = 0. 672,0. 712, all P 〈 0.01 ）, negatively correlated with NO（r = - 0.619,P 〈0.01 ） ,mPAP was positively correlated with ET-1 （r = 0. 712,P 〈 0.01 ）, negatively correlated with NO （r = - 0. 686, P 〈 0.01 ）. Level of mPAP and plasma ET-1 were significantly higher at 3 700 m 50 d than those at 1 500 m 12 h,15 d

关 键 词：肺动脉压 内皮素-1 一氧化氮 高海拔 

分 类 号：R541[医药卫生—心血管疾病] R594.3[医药卫生—内科学]