中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2011年
9期
539-542
,共4页
杨生岳%冯恩志%闫自强%贺巍%田忠新%殷和%马力夫%周其全%石自福
楊生嶽%馮恩誌%閆自彊%賀巍%田忠新%慇和%馬力伕%週其全%石自福
양생악%풍은지%염자강%하외%전충신%은화%마력부%주기전%석자복
肺动脉高压%低氧诱导因子-1α%血管内皮生长因子%高海拔
肺動脈高壓%低氧誘導因子-1α%血管內皮生長因子%高海拔
폐동맥고압%저양유도인자-1α%혈관내피생장인자%고해발
Pulmonary arterial hypertension%Hypoxia inducible factor-1α%Vascular endothelial growth factor%High altitude
目的 观察低氧诱导因子-1α(HIF-1α)和血管内皮生长因子(VEGF)在急性高原反应(AHAR)低氧性肺动脉高压(HPH)发生中的作用及返回低海拔后的变化。方法 选择2010年4月14日青海玉树大地震后由低海拔(1 500m)快速进入高海拔地区(3 700m)并从事重体力劳动的18～35岁男性官兵96名，根据AHAR症状评分分为无AHAR组(25名)、轻中度AHAR组(47名)和重度AHAR组(24名)；在高海拔地区停留50 d后下撤前及返回低海拔地区后12h、15d分别测定平均肺动脉压(mPAP)和血清HIF-1α、VEGF水平。同时选择低海拔地区50名健康官兵作为对照。结果 高海拔无AHAR组mPAP(mm Hg，1 mm Hg=0.133 kPa)和血清HIF-1α(pg/L)、VEGF(ng/L)水平（分别为24.23±1.56、68.80±7.52、82.56±6.32）明显高于低海拔对照组(18.50±1.30、50.95±3.33、65.78±4.03)；且随AHAR加重，各指标进一步升高，高海拔轻中度AHAR组分别为28.42±1.32、88.10±9.20、104.82±10.36，重度AHAR组分别为34.70±2.94、117,93±13.46、136.77±12.03，组间两两比较差异均有统计学意义(均P＜0.01)。高海拔AHAR总计分与mPAP、血清HIF-1α、VEGF水平均呈显著正相关(r值分别为0.672、0.737、0.634，均P＜0．01);mPAP与血清HIF- 1α、VEGF水平呈显著正相关(r值分别为0.706、0.638，均P＜0.01)。与低海拔对照组比较，96名官兵进入高海拔地区50 d时mPAP (mm Hg)和血清HIF- 1α (pg/I)、VEGF (ng/L)水平（分别为29.08±4.22、91.16±20.58、107.11±10.32）显著升高(均P＜0.01)，返回低海拔地区12 h(分别为23.05±3.18、70.99±8.22、78.65±6.47)、15 d（分别为18.96±1.75、52.31±4.92、63.08±4.55）时各指标显著下降，且15d明显低于12 d(均P＜0．01)，15d时各指标与低海拔对照组比较差异均无统计学意义(均P＞0.05)。结论 人体在高海拔低氧地区并从事重体力劳动时，AHAR越重，mPAP和血清HIF-1α、VEGF水平就越高，说明HPH与HIF-1α、VEGF水平升高有密切关系；返回低海拔地区后12h上述指标有显著改善，15d可恢复到正常水平。
目的 觀察低氧誘導因子-1α(HIF-1α)和血管內皮生長因子(VEGF)在急性高原反應(AHAR)低氧性肺動脈高壓(HPH)髮生中的作用及返迴低海拔後的變化。方法 選擇2010年4月14日青海玉樹大地震後由低海拔(1 500m)快速進入高海拔地區(3 700m)併從事重體力勞動的18～35歲男性官兵96名，根據AHAR癥狀評分分為無AHAR組(25名)、輕中度AHAR組(47名)和重度AHAR組(24名)；在高海拔地區停留50 d後下撤前及返迴低海拔地區後12h、15d分彆測定平均肺動脈壓(mPAP)和血清HIF-1α、VEGF水平。同時選擇低海拔地區50名健康官兵作為對照。結果 高海拔無AHAR組mPAP(mm Hg，1 mm Hg=0.133 kPa)和血清HIF-1α(pg/L)、VEGF(ng/L)水平（分彆為24.23±1.56、68.80±7.52、82.56±6.32）明顯高于低海拔對照組(18.50±1.30、50.95±3.33、65.78±4.03)；且隨AHAR加重，各指標進一步升高，高海拔輕中度AHAR組分彆為28.42±1.32、88.10±9.20、104.82±10.36，重度AHAR組分彆為34.70±2.94、117,93±13.46、136.77±12.03，組間兩兩比較差異均有統計學意義(均P＜0.01)。高海拔AHAR總計分與mPAP、血清HIF-1α、VEGF水平均呈顯著正相關(r值分彆為0.672、0.737、0.634，均P＜0．01);mPAP與血清HIF- 1α、VEGF水平呈顯著正相關(r值分彆為0.706、0.638，均P＜0.01)。與低海拔對照組比較，96名官兵進入高海拔地區50 d時mPAP (mm Hg)和血清HIF- 1α (pg/I)、VEGF (ng/L)水平（分彆為29.08±4.22、91.16±20.58、107.11±10.32）顯著升高(均P＜0.01)，返迴低海拔地區12 h(分彆為23.05±3.18、70.99±8.22、78.65±6.47)、15 d（分彆為18.96±1.75、52.31±4.92、63.08±4.55）時各指標顯著下降，且15d明顯低于12 d(均P＜0．01)，15d時各指標與低海拔對照組比較差異均無統計學意義(均P＞0.05)。結論 人體在高海拔低氧地區併從事重體力勞動時，AHAR越重，mPAP和血清HIF-1α、VEGF水平就越高，說明HPH與HIF-1α、VEGF水平升高有密切關繫；返迴低海拔地區後12h上述指標有顯著改善，15d可恢複到正常水平。
목적 관찰저양유도인자-1α(HIF-1α)화혈관내피생장인자(VEGF)재급성고원반응(AHAR)저양성폐동맥고압(HPH)발생중적작용급반회저해발후적변화。방법 선택2010년4월14일청해옥수대지진후유저해발(1 500m)쾌속진입고해발지구(3 700m)병종사중체력노동적18～35세남성관병96명，근거AHAR증상평분분위무AHAR조(25명)、경중도AHAR조(47명)화중도AHAR조(24명)；재고해발지구정류50 d후하철전급반회저해발지구후12h、15d분별측정평균폐동맥압(mPAP)화혈청HIF-1α、VEGF수평。동시선택저해발지구50명건강관병작위대조。결과 고해발무AHAR조mPAP(mm Hg，1 mm Hg=0.133 kPa)화혈청HIF-1α(pg/L)、VEGF(ng/L)수평（분별위24.23±1.56、68.80±7.52、82.56±6.32）명현고우저해발대조조(18.50±1.30、50.95±3.33、65.78±4.03)；차수AHAR가중，각지표진일보승고，고해발경중도AHAR조분별위28.42±1.32、88.10±9.20、104.82±10.36，중도AHAR조분별위34.70±2.94、117,93±13.46、136.77±12.03，조간량량비교차이균유통계학의의(균P＜0.01)。고해발AHAR총계분여mPAP、혈청HIF-1α、VEGF수평균정현저정상관(r치분별위0.672、0.737、0.634，균P＜0．01);mPAP여혈청HIF- 1α、VEGF수평정현저정상관(r치분별위0.706、0.638，균P＜0.01)。여저해발대조조비교，96명관병진입고해발지구50 d시mPAP (mm Hg)화혈청HIF- 1α (pg/I)、VEGF (ng/L)수평（분별위29.08±4.22、91.16±20.58、107.11±10.32）현저승고(균P＜0.01)，반회저해발지구12 h(분별위23.05±3.18、70.99±8.22、78.65±6.47)、15 d（분별위18.96±1.75、52.31±4.92、63.08±4.55）시각지표현저하강，차15d명현저우12 d(균P＜0．01)，15d시각지표여저해발대조조비교차이균무통계학의의(균P＞0.05)。결론 인체재고해발저양지구병종사중체력노동시，AHAR월중，mPAP화혈청HIF-1α、VEGF수평취월고，설명HPH여HIF-1α、VEGF수평승고유밀절관계；반회저해발지구후12h상술지표유현저개선，15d가회복도정상수평。
Objective To assess the effects of hypoxia inducible factor-1a (HIF-1a) and vascular endothelial growth factor (VEGF) on hypoxic pulmonary hypertension(HPH) in patients with acute high altitude reaction(AHAR) and its change after return to lower altitude. Methods Ninety-six officers and soldiers participating in rescue of Yushu megaseism on April 14th in 2010, leaving low altitude area (1 500 m) rapidly to high altitude area(3 700 m) to undertake strenuous physical work were enrolled for study. All of them were male, aged 18 - 35 years, and they were divided into three groups according to the symptomatic scores of AHAR: without AHAR (group B, n= 25), mild to moderate AHAR (group C,n=47) and severe AHAR (group D, n= 24). Mean pulmonary artery pressure (mPAP), levels in serum HIF-lα and VEGF were measured at high altitude area after a stay of 50 days, and also after their return to lower altitude area (1 500 m) for 12 hours and 15 days. Fifty healthy volunteers at low altitude area served as control (group A). Results Level of mPAP (mm Hg, 1 mm Hg=0. 133 kPa), serum HIF-lα (pg/L) and VEGF (ng/L) in group B (24. 23 ± 1.56, 68. 80± 7. 52 and 82.56± 6. 32) were significantly higher than those in group A (18. 50±1.30, 50. 95±3.33 and 65.78∶4. 03), respectively (all P＜0. 01). Moreover,the value of all the parameters increased with increase in severity of AHAR, the respective value in group C were 28. 42 ± 1.32, 88. 10 ± 9. 20 and 104. 82 ± 10. 36, and in group D were 34.70 ± 2.94, 117. 93 ± 13.46and 136. 77±12. 03, and there were significant differences in comparing two groups (all P＜0. 01). At high altitude area, AHAR total score was positively correlated with mPAP, serum HIF-1α and VEGF (r= 0. 672,0. 737 and 0. 634, respectively, all P＜0. 01), mPAP was positively correlated with serum HIF-1α and VEGF (r=0. 706, 0. 638, both P＜0. 01). Compared with group A, level of mPAP (29.08±4. 22), serum HIF-1α(91.16±20. 58) and VEGF (107. 11± 10. 32) were significantly increased in 96 officers and soldiers who stayed for 50 days at an altitude of 3 700 m (all P＜0. 01), and the values were significantly decreased after returning to lower altitude area for 12 hours (23. 05 ± 3. 18, 70. 99±8.22 and 78. 65±6.47) and 15 days (18. 96± 1.75, 52. 31±4. 92 and 63. 08±4. 55). The values showed significant difference between 12 hours and 15 days stay at 1 500 m (all P＜0. 01). The values of the determined parameters 15 days after return to lower altitude area showed no difference compared with those of group A (all P＞0. 05). Conclusion Strenuous physical work at high altitude area, AHAR becomes more serious, and it is accompanied by higher values of HIF-1α, VEGF and mPAP, indicating that HPH is closely associated with elevation of HIF-1α and VEGF. These changes are improved after returning to lower altitude area for 12 hours, and they recover to normal lever after 15 days.
