Sartori C, Vollenweider L, Löffler B M, Delabays A, Nicod P, Bärtsch P, Scherrer U
Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Circulation. 1999 May 25;99(20):2665-8. doi: 10.1161/01.cir.99.20.2665.
Exaggerated pulmonary hypertension is thought to play an important part in the pathogenesis of high-altitude pulmonary edema (HAPE). Endothelin-1 is a potent pulmonary vasoconstrictor peptide that also augments microvascular permeability.
We measured endothelin-1 plasma levels and pulmonary artery pressure in 16 mountaineers prone to HAPE and in 16 mountaineers resistant to this condition at low (580 m) and high (4559 m) altitudes. At high altitude, in mountaineers prone to HAPE, mean (+/-SE) endothelin-1 plasma levels were approximately 33% higher than in HAPE-resistant mountaineers (22.2+/-1.1 versus 16.8+/-1.1 pg/mL, P<0.01). There was a direct relationship between the changes from low to high altitude in endothelin-1 plasma levels and systolic pulmonary artery pressure (r=0.82, P<0.01) and between endothelin-1 plasma levels and pulmonary artery pressure measured at high altitude (r=0.35, P=0.05).
These findings suggest that in HAPE-susceptible mountaineers, an augmented release of the potent pulmonary vasoconstrictor peptide endothelin-1 and/or its reduced pulmonary clearance could represent one of the mechanisms contributing to exaggerated pulmonary hypertension at high altitude.
肺动脉高压被认为在高原肺水肿（HAPE）的发病机制中起重要作用。内皮素-1是一种强效的肺血管收缩肽，也会增加微血管通透性。
我们测量了16名易患HAPE的登山者和16名对HAPE有抵抗力的登山者在低海拔（580米）和高海拔（4559米）时的血浆内皮素-1水平和肺动脉压力。在高海拔时，易患HAPE的登山者的平均（±标准误）血浆内皮素-1水平比有HAPE抵抗力的登山者高出约33%（22.2±1.1对16.8±1.1 pg/mL，P<0.01）。从低海拔到高海拔，血浆内皮素-1水平的变化与收缩期肺动脉压力之间存在直接关系（r=0.82，P<0.01），且血浆内皮素-1水平与在高海拔时测量的肺动脉压力之间也存在直接关系（r=0.35，P=0.05）。
这些发现表明，在易患HAPE的登山者中，强效肺血管收缩肽内皮素-1的释放增加和/或其肺清除率降低可能是导致高海拔时肺动脉高压加剧的机制之一。
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