急性高原反应者肺血管活性因子水平与肺动脉压的关系及其返回低海拔后的变化

Relationship between pulmonary vasoactive factors and pulmonary arterial pressure in acute high altitude reaction and its change after return to lower altitude

目的观察急性高原反应(AHAR)者肺血管活性因子与肺动脉压(PAP)的关系及其返回低海拔后的变化。方法由低海拔进入高海拔的男性官兵96名。根据AHAR评分分为重度(A组,n=24)、轻中度(B组,n=47)和无AHAR组(C组,n=25),在该高度50 d后下撤前及返回低海拔后12 h、15 d测血浆IMD、ADM、ET-1、mPAP,并与低海拔50名健康官兵(D组)比较。结果 A组IMD、ADM、ET-1、mPAP高于B组、C组和D组(均P<0.01),B组与C组、C组与D组比较均P<0.01。AHAR症状计分与mPAP、IMD、ADM、ET-1和IMD、ADM、ET-1与mPAP呈正相关(均P<0.01)。海拔3 700 m 50 d,各参数高于海拔1 500 m 12 h、15 d和D组(均P<0.01),海拔1 500 m 12 h与15 d比较均P<0.01,海拔1 500 m 15 d与D组无差异性(均P>0.05)。结论 IMD、ADM、ET-1参与了AHAR者PAH的病理生理过程,其比例失衡可能是导致低氧性PAH发生的重要因素。返回低海拔后12 h显著改善,15 d恢复正常。

Objective To assess the relationship between pulmonary vasoactive factors and pulmonary arterial pressure（PAP） in acute high altitude reaction（AHAR） and its change after return to lower altitude.Methods 96 officers and soldiers of rapidly getting into high altitude（3700 m） combined strong physical work were analyzed.According to the symptomatic scores of AHAR,they were divided into 3 groups： severe（group A,n=24）,mild to moderate（group B,n=47） and without AHAR（group C,n=25）.Plasma intermedin（IMD）,adrenomedulin（ADM）,endothelin-1（ET-1） and mean pulmonary arterial pressure（mPAP） were measured at that altitude for 50 ds and after return to lower altitude（1500 m） for 12 hs and 15 ds and 50 healthy volunteers at 1500 m altitude served as controll（group D）.Results Level of plasma IMD,ADM,ET-1 and mPAP were significantly higher in group A than those in group B,C and D（all P〈0.01）,and there were significantly differences between the group B and group C,also group C and group D（all P〈0.01）.At altitude 3700 m for 50 ds,AHAR total scores were positively correlated with mPAP,IMD,ADM and ET-1,IMD,ADM and ET-1 was positively correlated with mPAP（all P〈0.01）.mPAP,IMD,ADM and ET-1 were significantly higher at 3700 m for 50 ds than those at 1500 m for 12 hs,15 ds and the group D（all P〈0.01）;there was significantly difference at 1 500 m between 12 h and 15 d（all P〈0.01）;there were no difference between at 15 d and the group D（all P〉0.05）.Conclusion IMD,ADM and ET-1 may play important roles in mechanism of PAH in AHAR.Imbalance of these factors has great effects on the development of hypoxic pulmonary hypertasion.It was obviously improved after return to lower altitude 12 h,and recovered to normal after 15 d.