急进高原环境对血管内皮功能的影响及其与急性高原病的关系  

Effects of rapid entrance into plateau area on the vascular endothelial function and the relationship to acute mountain sickness

作　　者：邱友竹 余洁[1] 王连友[1] 梁逍 杨杰[1] 张恩浩[1] 黄岚[1] 

机构地区：[1]第三军医大学新桥医院心血管内科、全军心血管病研究所,重庆400037

出　　处：《解放军医学杂志》2015年第5期415-419,共5页Medical Journal of Chinese People's Liberation Army

基　　金：国家卫生部卫生行业科研专项基金(201002012)~~

摘　　要：目的观察人群急进高原后血管内皮功能相关指标的变化,并探讨其与急性高原病(AMS)的关系。方法在平原地区招募32名受试者,以汽车方式急进高原(海拔3900m)。进入高原第5天根据路易斯湖量表评分,将受试者分为AMS+组(n=14)和AMS–组(n=18)。ELISA法检测人群血清一氧化氮(NO)、内皮素-1(ET-1)、血管内皮生长因子(VEGF)、血管内皮钙黏蛋白(VE-cadherin)、丙二醛(MDA)及超氧化物歧化酶(SOD)等指标的变化。采用Pearson相关法分析上述指标与AMS的关系。结果急进高原后第5天时32名受试者中AMS的发生率为43.8%。与平原相比,受试者急进高原后血清NO、SOD水平明显降低(P<0.05,P<0.01),ET-1和MDA水平明显升高(P<0.05)。与AMS–人群比较,AMS+人群NO、VEGF和VE-cadherin、SOD水平均明显降低(P<0.05,P<0.01),ET-1水平明显升高(P<0.01)。相关性分析显示,急性高原暴露第5天人群血清NO、VEGF、VE-cadherin、SOD水平与AMS呈显著负相关,ET-1水平与AMS呈显著正相关。结论急进高海拔环境可能导致血管内皮功能受损,血管内皮功能相关指标的变化可能为AMS的预警及诊断提供参考。Objective To observe the changes in the vascular endothelial function indexes in subjects who enter plateau areas expeditiously, and investigate the relationship between their changes and acute mountain sickness（AMS）. Methods Thirtytwo healthy young male lowlands residents were recruited as subjects, and they were sent by bus to an area of altitude of 3900 m. According to the score of Lake Louise questionnaire, the subjects were divided into AMS＋ and AMS– group at the 5th day after the entrance into plateau. The changes in the vascular endothelial function indexes（NO, ET-1, VEGF, VE-cadherin, MDA and SOD） in serum of the subjects were detected by ELISA. Pearson correlation analysis was performed to identify the relationship of AMS to the changes of the indexes mentioned above. Results On the 5th day after being exposed to high altitude, the incidence of AMS was 43.8%（14/32）. The serum levels of NO and SOD in subjects were significantly lowered（P〈0.05 and P〈0.01, respectively） compared with those before the entrance into high altitude area, while the levels of ET-1 and MDA were obviously elevated（P〈0.05）. However, the levels of VEGF and VE-cadherin showed no obvious change in the subjects as compared before and after the entrance into plateau area. After the entrance into the plateau, the levels of NO, VEGF, VE-cadherin and SOD were lowered obviously and ET-1 level increased significantly in AMS＋ group as compared with those in AMS？ group（P〈0.05 and P〈0.01, respectively）. Correlation analysis showed that the serum levels of NO, VEGF, VE-cadherin and SOD were negatively correlated with AMS after a 5-day high altitude exposure, while serum level of ET-1 was positively correlated with AMS. Conclusions Rapid entrance into plateau area may induce damage to vascular endothelial function of the subjects, and it affects the serum levels of NO, ET-1, VEGF, VE-cadherin and SOD. The changes in these indexes may provide the potential basis for prewarning and diagnosis of AMS.

关 键 词：高原病 一氧化氮 内皮素-1 血管内皮生长因子类 

分 类 号：R594.3[医药卫生—内科学]