高原脱适应与急性高原反应及心脏功能的关系

Relationship of high altitude de-adaptation with acute high altitude response and cardiac function

目的:探讨高原脱适应反应(HADAR)与急性高原反应(AHAR)及心脏功能的关系。方法:由低海拔(1 500 m)进入高原(3 700～4 800 m)并从事重体力作业的男性军人96名,年龄18～35岁。在高原上,根据AHAR症状评分分为重度组(A组,24)、轻中度组(B组,47)和无AHAR组(C组,25)。返回低海拔后,根据HADAR症状评分分为重度组(E组,19)、轻中度组(F组,40)和无HADAR组(G组,37)。在该高度停留50 d后下撤前和返回低海拔(1 500 m)后12 h、15 d、30 d分别测平均肺动脉压(mPAP)、右心室内径(RVID)、右心室流出道(RVOT)、左心室内径(LVID)、左心室射血分数(LVEF)、心肌做功指数(Tei指数)、血清肌酸激酶同功酶-MB(CKMB)、乳酸脱氢酶同功酶-1(LDH-1)浓度,并与低海拔(1 500 m)50名健康军人(D组)比较。结果:A组mPAP、RVID、RVOT、RVID/LVID比值、Tei指数、CK-MB、LDH-1水平显著高于,LVEF显著低于B组、C组和D组,B组与C组之间和C组与D组之间亦有显著性差异(P均<0.01),LVID各组之间无统计学差异(P均>0.05)。AHAR总计分与HADAR总计分呈显著正相关(r=0.863,P<0.01)。返回低海拔12 h,E组mPAP、RVID、RVOT、RVID/LVID比值、Tei指数、CK-MB、LDH-1水平显著高于,LVEF显著低于F组、G组和D组,F组与D组之间和G组与D组之间亦有显著性差异(P均<0.01)。返回低海拔15 d,E组mPAP、RVID、RVOT、RVID/LVID比值显著高于F组、G组和D组(P<0.01或P<0.05),F组与G组和D组之间亦有显著性差异(P<0.01或P<0.05),但G组与D组之间差异无显著性(P均>0.05),LVEF、Tei指数、CK-MB、LDH-1各组间差异无显著性(P均>0.05)。返回低海拔30 d,E、F、G组各项指标与D组比较均无显著性差异(P均>0.05)。结论:HADAR程度与AHAR、心脏受损程度密切相关,在高原AHAR和心脏受损越重,返回低海拔HADAR和心脏受损越重,右心形态学受损恢复时间越长。

Objective： To assess the relationship of high altitude de-adaptation response（HADAR） with acute high altitude response （AHAR） and cardiac function. Methods： Ninety-six military personnel of rapid entering into high altitude （3 700 to 4 800 m） with 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： sever AHAR （group A,24） ,mild to moderate AHAR （group B,47） and non-AHAR （group C,25） at high altitude. According to the symptomatic scores of HAD AR were divided into 3 groups： severe HAD AR （group E, 19）, mild to moderate HAD AR （group F, 40） and non-HADAR （group G,37） after retum to lower altitude （ 1 500 m）. Mean pulmonary arterial pressure （mPAP） ,right ventricular intemal dimension （RVID）, outflow tract of fight ventricle （ RVOT）, left ventricular internal dimension （LVID）, left ventricular ejection fraction （LVEF）,cardiac muscle work index （Tei index）, creatine kinase isoenzymes-MB （CK-MB）, lactic dehydrogenase isoenzyme-1 （LDH-1） were measured at high altitude stayed 50 days and after return to lower altitude 12 h, 15 d, and 30 d. Fifty healthy volunteers （group D） at 1 500 m altitude served as control. Results： Level of mPAP, RVID, RVOT, RVID/LVID ratio, Tei index, CK-MB, and LDH- 1 were higher, and LVEF was lower in group A than those in group B, C and D, there were significant differences between group B and C, C and D （all P 〈 0.01）. AHAR scores were positively correlated with HADAR scores （ r =0.863, P 〈 0.01 ）. Twelve hours after return to lower altitude, level of mPAP,RVID,RVOT, RVID/LVID ratio,Tei index, CK-MB, and LDH-1 were higher, and LVEF was lower in group E than those in group F,G and D, there were significant differences between group F and G, G and D （all P 〈 0.01 ）. Fifteen days after return to lower altitude, level of mPAP, RVID,RVOT,RVID/LVID ratio were higher in group E than those in group F,G, and D, there were significant differences between group F and G, and D（ P 〈 0. 01 or P 〈 0. 05）, there were no significant differences between group G and D（all P 〉 0. 05）, LVEF, Tei index, CK-MB, LDH-1 showed no significant differences among groups （all P 〉 0. 05）. Thirty days after return to lower altitude, these parameters in group E, F, and G showed no significantly differences compared with those of group D （ all P 〉 0.05）. Conclusion： The severity of HADAR is associated with severity of AHAR and cardiac injury, the more serious of AHAR and cardiac injury at high altitude, the more serious of HADAR and cardiac injury after return to lower altitude, the more long of restore of right cardiac morphologic injury.