高原环境对健康成人内分泌激素水平的影响及激素水平变化与生化指标的相关性

Effects of high altitude on endocrine hormone levels in healthy adults and correlation between changes in hormone levels and biochemical indicators

背景高原低压低氧环境可导致机体多种内分泌激素水平发生改变,但既往研究结果并不一致。目的进一步了解高原环境对健康成人内分泌系统激素水平的影响。方法选取由甘肃兰州(海拔1500 m)进驻西藏阿里地区(海拔4300 m)1年的健康官兵血液标本,采用放射免疫分析法和化学发光法对醛固酮、皮质醇、甲状腺激素、性激素水平进行测定,同步测定基本生化指标。结果共纳入98例官兵进行分析,男性59例,年龄(31.07±7.50)岁;女性39例,年龄(36.05±5.56)岁。进驻高原1年后,不同性别受试者血中醛固酮和皮质醇水平均未见显著改变,游离三碘甲状腺原氨酸(free triiodothyronine,FT3)显著降低(P<0.05),反三碘甲状腺原氨酸(reverse triiodothyronine,RT3)水平显著升高(P<0.05);男性受试者的总三碘甲状腺原氨酸(total triiodothyronine,TT3)水平较进驻高原前显著升高(P<0.05)。此外,驻守高原1年后健康男性体内卵泡刺激素(follicle-stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、催乳素(prolactin,PRL)三种激素水平均显著升高(P<0.05),血中睾酮(testosterone,T)水平显著降低(P<0.05)。进驻高原女性T水平显著升高(P<0.05),雌二醇(estradiol,E2)水平呈现下降趋势,但与进驻高原前比较差异无统计学意义(P=0.067)。其次,高原环境使男性谷丙转氨酶(alanine aminotransferase,ALT)、谷氨酰转肽酶(glutamyl transpeptidase,GGT)水平降低(P<0.05),胆红素水平显著升高(P<0.05);同等条件下,女性受试者ALT、总胆红素(total bilirubin,T-BIL)和间接胆红素(indirect bilirubin,I-BIL)及二者异常率均显著升高(P<0.05),尿素氮(blood urea nitrogen,BUN)和肌酐(creatinine,CREA)水平显著升高(P<0.05)。分析生化指标与激素水平变化的相关性发现,男性LH水平与T-BIL(r=0.315,P<0.05)和I-BIL(r=0.336,P<0.05)水平呈正相关,RT3水平与直接胆红素(direct bilirubin,D-BIL)的变化也呈正相关关系(r=0.330,P<0.05),FT3与BUN/CREA呈负相关(r=-0.382,P<0.05);而女性T水平与T-BIL(r=0.490,P<0.05)、D-BIL(r=0.389,P<0.05)和I-BIL(r=0.495,P<0.05)水平均呈正相关,E2水平与T-BIL(r=-0.452,P<0.05)和I-BIL(r=-0.449,P<0.05)水平呈负相关。结论高原驻守1年对健康成人体内甲状腺激素、性激素水平均有不同程度的影响;激素水平的改变与机体肝、肾功能的变化存在相关性。上述改变是机体维持内环境相对平衡以适应高原环境的表现。

Background The low-pressure and low-oxygen environment at high altitude leads to changes in the levels of various endocrine hormones.However,the results of previous studies are inconsistent.Objective To investigate the effects of high altitude on endocrine hormone levels in healthy adults.Methods The blood samples were collected from 98 healthy soldiers(59 males,31.07±7.50 years old;39 females,36.05±5.56 years old)who entered from Lanzhou(1500 m)to Ngari(4300 m)for one year.Radioimmunoassay and chemiluminescence were used to detect the levels of aldosterone,cortisol,thyroid hormone,sex hormone and biochemical indicators in soldiers.Results Totally 98 healthy soldiers were enrolled,including 59 males aged 31.07±7.50 years old and 39 females aged 36.05±5.56 years old.There were no significant changes in serum aldosterone and cortisol levels in subjects of different genders after one year in Ngari.The level of free triiodothyronine(FT3)significantly decreased(P<0.05),while the level of anti-triiodothyronine(RT3)significantly increased(P<0.05)comparing with that before entering to the plateau.In addition,the level of total triiodothyronine(TT3)in male was higher than that in control subjects(P<0.05).Moreover,the levels of follicle stimulating hormone(FSH),luteinizing hormone(LH)and prolactin(PRL)in healthy men increased obviously after one year of stationing at high altitude(P<0.05).In contrast,blood testosterone(T)levels reduced significantly(P<0.05).For women,T level increased significantly(P<0.05),and estradiol(E2)level showed a downward trend after one year in Ngari,but the difference was not statistically significant(P=0.067).Furthermore,the levels of alanine aminotransferase(ALT)and glutamyl transpeptidase(GGT)decreased(P<0.05),and the level of bilirubin increased significantly(P<0.05)in male.Under the same condition,ALT,total bilirubin(T-BIL),indirect bilirubin(I-BIL)and their abnormal rates increased significantly in female subjects(P<0.05),and the levels of blood urea nitrogen(BUN)and creatinine(CREA)also significantly increased(P<0.05).The correlation analysis between biochemical indexes and hormone levels in male showed that the LH level was positively correlated with the changes of T-BIL(r=0.315,P<0.05)and I-BIL(r=0.336,P<0.05).RT3 level was also positively correlated with direct bilirubin(D-BIL)(r=0.330,P<0.05),while FT3 was negatively correlated with BUN/CREA(r=-0.382,P<0.05).In female,the T level was positively correlated with T-BIL(r=0.490,P<0.05),D-BIL(r=0.389,P<0.05)and I-BIL(r=0.495,P<0.05).E2 level was negatively correlated with T-BIL(r=-0.452,P<0.05)and I-BIL(r=-0.449,P<0.05).Conclusion Living at high altitude for one year has a certain degree of influence on the levels of thyroid hormone and sex hormone in healthy adults.In addition,there is a correlation between the change of hormone levels and liver renal function.The above changes are adaptive mechanism of the body to maintain the relative balance of internal environment to adapt to the plateau environment.