高海拔地区(4100 m)不同健康人群微循环特征及其体液因子的变化

Microcirculation characteristics and humoral factors of healthy people from different populations at high altitude(4100 m)

本研究旨在探讨青海省果洛藏族自治州(海拔4100 m)三个不同健康人群(世居藏族、久居汉族、移居武警)舌下微循环特征及其体液因子的变化。选取青海省果洛藏族自治州30名年龄为(45.62±10.15)岁的世居藏族健康人为世居组,22名年龄为(46.23±8.59)岁的久居汉族健康人为久居组,23名年龄为(43.45±8.31)岁的移居武警健康人为移居组;均抽取静脉血进行血常规分析:白细胞(white blood cell,WBC)计数、红细胞(red blood cell,RBC)计数、血红蛋白浓度(hemoglobin,HGB)、红细胞压积(hematocrit,HCT)、血小板(platelet,PLT)计数、中性粒细胞比例(NEUT);ELISA检测血清体液因子内皮素1(endothelin-1,ET-1)、CD31、CD34、CD105、血管内皮生长因子(vascularendothelialgrowthfactor,VEGF)、NO、去甲肾上腺素(noradrenaline,NE)等指标的变化;应用连续无创血流动力学监测仪连续测定体循环心输出量(cardiac output,CO)、心脏指数(cardiac index,CI)、心率(heart rate,HR)、每搏量(stroke volume,SV)、脉压变化率(pulse pressure variation,PPV)、全身血管阻力指数(systemic vascular resistance index,SVRI)、平均动脉压(mean artery pressure,MAP)等指标变化;应用脉氧监测仪检测脉搏血氧饱和度(SPO2);同时用旁流暗视野成像(sidestream dark-field imaging,SDF)监测技术观察舌下微循环总血管密度(total vascular density,TVD)、灌注血管密度(perfused vessel density,PVD)、灌注血管比例(proportion of perfused vessels,PPV)、微血管流动指数(microvascular flow index,MFI)等指标变化。结果显示,高海拔地区不同健康人群体循环指标比较无显著差异;与世居组比较,久居组和移居组微循环TVD、PVD明显增加(P<0.05);与世居组和久居组比较,移居组血常规指标WBC、RBC、HGB、HCT明显升高(P<0.05),与久居组和移居组比较,世居组的PLT明显升高(P<0.05);与世居组比较,移居组血清体液因子CD105、VEGF明显升高(P<0.05),与久居组和移居组比较,世居组的NO明显升高(P<0.05)。以上结果提示,高海拔地区不同健康人群微循环(TVD、PVD)、血常规(WBC、RBC、HGB、HCT)和体液因子(CD105、VEGF)比较具有明显差异,特别是久居与移居人群在低压低氧环境下微循环增加、红细胞增多、促血管生成因子增高,这种特征性的变化具有特殊的生理意义,对救治高原地区不同人群感染性休克及慢性高原病具有指导价值。

The present study was aimed to observe the characteristics of sublingual microcirculation and the changes of humoral factors in healthy people of three different high altitude populations.Three groups of healthy subjects in Guoluo area of Qinghai province(4100 m)were included:Tibetan group:30 Tibetans,(45.62±10.15)years old;Han group:22 two-generation of Han immigrants,(46.23±8.59)years old;migrant group:23 migrants living at high altitude for 2–5 years,(43.45±8.31)years old.Blood routine test was performed to determine white blood cell(WBC)count,red blood cell(RBC)count,hemoglobin(HGB),hematocrit(HCT),platelet(PLT)count,and neutrophil(NEUT)count.The changes of serum humoral factors including endothelin-1(ET-1),CD31,CD34,CD105,vascular endothelial growth factor(VEGF),nitric oxide(NO)and noradrenaline(NE)were detected by ELISA.Continuous noninvasive hemodynamics monitor was used to continuously measure the changes of systemic circulation indexes:cardiac output(CO),cardiac index(CI),heart rate(HR),stroke volume(SV),pulse pressure variation(PPV),systemic vascular resistance index(SVRI),and mean arterial pressure(MAP).Blood oxygen was measured by pulse oximeter.Sublingual microcirculation indexes including total vascular density(TVD),perfused vessel density(PVD),proportion of perfused vessels(PPV),and microvascular flow index(MFI)were determined by sidestream dark field imaging.The results showed that there were no difference in systemic circulation among the 3 groups.Compared with Tibetan group,TVD and PVD of microcirculation in Han group and migrant group were significantly increased(P<0.05).Compared with Tibetan group and Han group,WBC,RBC,HGB and HCT of migrant group were significantly increased(P<0.05).Compared with Han group and Migrant group,PLT of Tibetan group was significantly increased(P<0.05).Compared with the Tibetan group,the levels of serum humoral factors CD105 and VEGF were significantly higher in the migrant group(P<0.05),while compared with Han and migration groups,NO in Tibetan group was significantly increased(P<0.05).It is suggested that there were significant differences in microcirculation(TVD,PVD),blood routine(WBC,RBC,HGB,HCT)and humoral factors(CD105,VEGF)among different populations in high altitude area.Importantly,the increased microcirculation,erythrocytosis and increased pro-angiogenic factors due to hypoxic environment were observed in long-term residents and migrants,except for permanent residents.These physiological changes have clinical significance in the treatment of septic shock and chronic altitude sickness for different plateau populations.