重度急性高原病的临床诊断及预测指标研究

doi:10.3877/cma.j.issn.1674-6880.2020.01.009

目的

观察健康平原地区人群急进高原后多项生理指标的变化，研究其对重度急性高原病（AMS）的诊断及预测价值。

方法

选取2017年6月至2019年6月解放军联勤保障部队第九七〇医院赴青海玉树的30例健康医务人员，根据Lake Louise评分（LLS）将30例医务人员分为重度AMS组（5例）和非重度AMS组（25例）。比较两组人员的一般资料及其进入高原后的缺氧诱导因子1α（HIF-1α）蛋白、血氧饱和度、血红蛋白、红细胞计数、白细胞计数、血小板计数、白细胞介素6（IL-6）及超敏C反应蛋白（hs-CRP）表达水平；采用Pearson相关分析各指标与LLS评分的相关性。

结果

急进高原后30例医务人员中重度AMS的发病率为16.7%（5/30）。重度AMS组体质量[（53 ± 6）kg vs.（68 ± 8）kg]、体质量指数（BMI）[（19.8 ± 0.8）kg/m² vs.（23.9 ± 1.9）kg/m²]、血氧饱和度[（84.0 ± 1.0）% vs.（87.7 ± 2.7）%]、血红蛋白[（135.0 ± 2.0）g/L vs.（161.1 ± 22.7）g/L]及红细胞计数[（4.5 ± 0.4）× 10¹²/L vs.（5.3 ± 0.5）× 10¹²/L]表达水平均较非重度AMS组显著降低（t = 1.093、2.789、3.386、7.872、0.028，P = 0.020、0.008、0.031、0.021、0.028）；而HIF-1α蛋白[（3.4 ± 0.3）vs.（0.9 ± 0.7）]表达水平较非重度AMS组显著升高（t = 2.870，P = 0.009）。Pearson相关分析结果显示，HIF-1α与LLS评分呈正相关（r = 0.883，P = 0.004），而血氧饱和度、红细胞计数、血红蛋白及BMI与LLS评分均呈负相关（r = -0.648、-0.750、-0.967、-0.549，P = 0.031、0.008、< 0.001、0.002）。

结论

HIF-1α、血氧饱和度、血红蛋白、红细胞计数及BMI可作为预测和评价重度AMS的良好指标。

关键词: 缺氧诱导因子1α, 重度急性高原病, Lake Louise评分

Objective

To observe physiological indices of healthy plain people rushing into a plateau, and to study their diagnostic and predictive value for the severe acute mountain sickness (AMS).

Methods

From June 2017 to June 2019, 30 healthy medical personnel were selected from the 970th Hospital of the PLA Joint Logistic Support Force to Yushu, Qinghai. According to the Lake Louise score (LLS), they were divided into a severe AMS group (n = 5) and a non-severe AMS group (n = 25). The general data, hypoxia inducible factor-1 alpha (HIF-1α) protein, oxygen saturation, hemoglobin, erythrocyte count, leukocyte count, platelet count, interleukin-6 (IL-6) and hypersensitive C-reactive protein (hs-CRP) were compared between these two groups after entering the plateau. Pearson correlation was used to analyze the correlation between each index and LLS.

Results

The incidence of severe AMS was 16.7% (5/30) among the 30 medical staff after rushing into the plateau. The weight [(53 ± 6) kg vs. (68 ± 8) kg], body mass index (BMI) [(19.8 ± 0.8) kg/m² vs. (23.9 ± 1.9) kg/m²], oxygen saturation [(84.0 ± 1.0)% vs. (87.7 ± 2.7)%], hemoglobin [(135.0 ± 2.0) g/L vs. (161.1 ± 22.7) g/L] and erythrocyte count [(4.5 ± 0.4) × 10¹²/L vs. (5.3 ± 0.5) × 10¹²/L] of the severe AMS group were significantly lower than those of the non-severe AMS group (t = 1.093, 2.789, 3.386, 7.872, 0.028; P = 0.020, 0.008, 0.031, 0.021, 0.028), whereas the expression of HIF-1α protein [(3.4 ± 0.3) vs. (0.9 ± 0.7)] was significantly higher (t = 2.870, P = 0.009). Pearson correlation analysis showed a positive correlation between HIF-1α and LLS (r = 0.883, P = 0.004), while the oxygen saturation, erythrocyte count, hemoglobin and BMI were negatively correlated with LLS (r = -0.648, -0.750, -0.967, -0.549; P = 0.031, 0.008, < 0.001, 0.002).

Conclusion

HIF-1α, oxygen saturation, hemoglobin, erythrocyte count and BMI can be used as good indicators to predict and evaluate severe AMS.

Key words: Hypoxia inducible factor-1 alpha, Severe acute mountain sickness, Lake Louise score

表1 两组医务人员一般资料比较（ ± s）

组别	例数	年龄（岁）	性别比（例，男/女）	身高（cm）	体质量（kg）	BMI（kg/m²）
重度AMS组	5	35.0 ± 2.6	1/4	163 ± 9	53 ± 6	19.8 ± 0.8
非重度AMS组	25	39.6 ± 5.9	15/10	168 ± 8	68 ± 8	23.9 ± 1.9
t/χ²值	?	2.690	-	0.215	1.093	2.789
P值	?	0.320	0.157	0.396	0.020	0.008

表1 两组医务人员一般资料比较（ ± s）

组别	例数	年龄（岁）	性别比（例，男/女）	身高（cm）	体质量（kg）	BMI（kg/m²）
重度AMS组	5	35.0 ± 2.6	1/4	163 ± 9	53 ± 6	19.8 ± 0.8
非重度AMS组	25	39.6 ± 5.9	15/10	168 ± 8	68 ± 8	23.9 ± 1.9
t/χ²值	?	2.690	-	0.215	1.093	2.789
P值	?	0.320	0.157	0.396	0.020	0.008

表2 两组医务人员进入高原后各指标表达水平比较（ ± s）

组别	例数	HIF-1α蛋白	血氧饱和度（%）	血红蛋白（g/L）	红细胞计数（× 10¹²/L）	白细胞计数（× 10⁹/L）	血小板计数（× 10⁹/L）	IL-6（ng/L）	hs-CRP（mg/L）
重度AMS组	5	3.4 ± 0.3	84.0 ± 1.0	135.0 ± 2.0	4.5 ± 0.4	6.1 ± 1.1	341 ± 69	4.3（3.1，5.4）	0.0（0.0，1.5）
非重度AMS组	25	0.9 ± 0.7	87.7 ± 2.7	161.1 ± 22.7	5.3 ± 0.5	8.1 ± 0.9	290 ± 75	3.7（2.3，5.4）	0.0（0.0，2.2）
t/H值	?	2.870	3.386	7.872	0.028	0.159	0.026	0.816	0.223
P值	?	0.009	0.031	0.021	0.028	0.057	0.185	0.414	0.824

表2 两组医务人员进入高原后各指标表达水平比较（ ± s）

组别	例数	HIF-1α蛋白	血氧饱和度（%）	血红蛋白（g/L）	红细胞计数（× 10¹²/L）	白细胞计数（× 10⁹/L）	血小板计数（× 10⁹/L）	IL-6（ng/L）	hs-CRP（mg/L）
重度AMS组	5	3.4 ± 0.3	84.0 ± 1.0	135.0 ± 2.0	4.5 ± 0.4	6.1 ± 1.1	341 ± 69	4.3（3.1，5.4）	0.0（0.0，1.5）
非重度AMS组	25	0.9 ± 0.7	87.7 ± 2.7	161.1 ± 22.7	5.3 ± 0.5	8.1 ± 0.9	290 ± 75	3.7（2.3，5.4）	0.0（0.0，2.2）
t/H值	?	2.870	3.386	7.872	0.028	0.159	0.026	0.816	0.223
P值	?	0.009	0.031	0.021	0.028	0.057	0.185	0.414	0.824

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Study on clinically diagnostic and predictive indicators for severe acute mountain sickness

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Study on clinically diagnostic and predictive indicators for severe acute mountain sickness