高原不同血红蛋白水平人群血液流变特征与组织供氧的研究

Hemorheological characteristics and tissue oxygen supply in people with different hemoglobin levels at high altitude

目的探讨高原不同血红蛋白(Hemoglobin, Hb)水平人群血液流变特征与组织供氧的差异。方法选择世居高原地区不同Hb水平的志愿者及久居平原Hb正常的志愿者,按来源地区和不同Hb水平分为4组,并设立A组为对照组,B、C、D为实验组,其中:A组:25例,要求世居高原,Hb[男性:(120~185)g·L^(-1),女性:(115~165)g·L^(-1)];B组:17例:要求世居高原,Hb[男性:(185~210)g·L^(-1),女性:(165~190)g·L^(-1)];C组:13例:要求世居高原,符合高原红细胞增多症诊断标准,Hb[男性:>210 g·L^(-1),女性:>190 g·L^(-1)];D组:25例:要求世居平原,Hb[男性:(120~185)g·L^(-1),女性:(115~165)g·L^(-1)]。各组分别采集静脉血10 mL,按不同检测项目取标本完成血常规、血液流变学、组织供氧指数、凝血功能及红细胞内ATP含量、P50、2,3-DPG等检测。结果 B、C、D 3组的红细胞变形指数TK与对照组A组相比,C组的红细胞变形指数TK降低(P<0.05),而B、D组差异均无统计学意义(P>0.05)。B、C、D 3组的组织供氧指数1 s^(-1)、5 s^(-1)、50 s^(-1)、100 s^(-1)、200 s^(-1)分别与对照组A组相比,C组的全血低切变率(1 s^(-1)、5 s^(-1))、高切变率(200 s^(-1))组织供氧指数降低(P<0.05);D组的全血中切变率(50 s^(-1))、高切变率(100 s^(-1)、200 s^(-1))组织供氧指数增高(P<0.05),而B组的全血低切变率(1 s^(-1)、5 s^(-1))、中切变率(50 s^(-1))、高切变率(100 s^(-1)、200 s^(-1))组织供氧指数差异均无统计学意义(P>0.05)。与对照组A组相比,B、C、D 3组的ATP含量、P50、2,3-DPG差异均无统计学意义(P>0.05)。结论高原红细胞增多症人群较高原正常人群组织供氧明显降低,平原正常人群较高原正常人群组织供氧增加。

Objective To explore the difference of Hemorheological characteristics and the oxygen content of tissue on different levels of hemoglobin(Hb) which were from Tibetan plateau. Methods Volunteers with different Hb levels living in Tibetan plateau and normal Hb levels living in plain were selected and divided into 4 groups according to their source areas and different Hb levels. Group A was set as the control group, while B、 C and D were set as the experimental group. In group A, 25 cases, who were required to live in plateau with Hb[male:(120~185)g·L^(-1), female:(115~165)g·L^(-1)]. Group B: 17 cases, required habitat plateau with Hb[male:(185~210)g·L^(-1), female:(165~190)g·L^(-1)]. In group C, 13 cases, who were required to live in plateau with Hb(male: >210 g·L^(-1), female: >190 g·L^(-1)). Group D: 25 cases, who were required to live in plain with Hb[male:(120~185)g·L^(-1), female:(115~165)g·L^(-1)]. 10 mL of Venous blood was collected from each case, these blood samples were be tested for blood routine, hemorheology, tissue oxygen supply index, coagulation function and ATP content in erythrocyte, P50, 2,3-DPG. Results Compared with group A, erythrocyte deformability index(TK) of group C decreased(P<0.05), while there was no significant difference between group B and D(P>0.05). Compared with group A, the blood shear rate 1 s^(-1), 5 s^(-1), and 200 s^(-1) of tissue oxygen supply index of group C decreased(P<0.05), the blood shear rate 50 s^(-1), 100 s^(-1) and 200 s^(-1)of tissue oxygen supply index of group D increased(P<0.05), while there was no statistically significant difference in the blood shear rate 1 s^(-1), 5 s^(-1),50 s^(-1), 100 s^(-1) and 200 s^(-1)of tissue oxygen supply index of group B(P>0.05).There was no statistically significant difference in ATP, P50 and 2,3-DPG of red blood cells among all groups(P>0.05). Conclusion In the plateau population, The tissue oxygen supply in patient with polycythemia was significantly lower than the people with normal Hb level. The tissue oxygen supply in the plain normal population was significantly higher than that in the plateau normal population.