Appenzeller O, Thomas P K, Ponsford S, Gamboa J L, Cáceda R, Milner P
New Mexico Health Enhancement and Marathon Clinics Research Foundation, Albuquerque, NM 87122, USA.
Neurology. 2002 Nov 26;59(10):1532-5. doi: 10.1212/01.wnl.0000034761.86543.a1.
Thirty-nine percent of permanent altitude dwellers in the Andes experience acral paresthesias.
Clinical examinations, sural nerve biopsies, and electrodiagnostic studies on peripheral nerves were performed on 15 men. Ten Cerro de Pasco (CP) natives living at 4,338 meters were biopsied. Three of these subjects had no burning feet/burning hands (BF/BH); three had BF/BH; and four had chronic mountain sickness (CMS), a maladaptation syndrome resulting from living in the Andes, all with BF/BH. Three patients with CMS were biopsied in Lima within hours after leaving CP. Two normal Lima natives were biopsied in Lima. Symptom scores for BF/BH and CMS score ratings were used. The nerves were assayed for Na+, K+ adenosine triphosphatase (ATPase), cytochrome oxidase (CO), substance P (SP), and endothelin (ET).
Low ATPase was inversely related to symptom scores and CMS scores (p < 0.001). Patients with CMS biopsied in normoxia (Lima) had ATPase levels similar to those of controls. Nerve motor conduction velocities and sensory action potentials were normal. CO was inversely related to age (p < 0.03) and no relation of SP to any variable was found. ET levels were lower in sea level natives (p = 0.04).
Acral paresthesias are associated with low ATPase in peripheral nerves. Lower ET levels of sea level natives likely reflect lowered release from vasa nervorum.
安第斯山脉39%的长期高原居住者会出现肢体感觉异常。
对15名男性进行了临床检查、腓肠神经活检以及外周神经电诊断研究。对10名居住在海拔4338米的塞罗德帕斯科（CP）本地人进行了活检。其中3名受试者无足部烧灼感/手部烧灼感（BF/BH）；3名有BF/BH；4名患有慢性高山病（CMS），这是一种因生活在安第斯山脉导致的适应不良综合征，均伴有BF/BH。3名CMS患者在离开CP数小时后于利马接受活检。对2名正常的利马本地人在利马进行活检。使用了BF/BH症状评分和CMS评分等级。对神经进行钠、钾三磷酸腺苷酶（ATPase）、细胞色素氧化酶（CO）、P物质（SP）和内皮素（ET）检测。
低ATPase与症状评分和CMS评分呈负相关（p < 0.001）。在常氧环境（利马）下接受活检的CMS患者的ATPase水平与对照组相似。神经运动传导速度和感觉动作电位正常。CO与年龄呈负相关（p < 0.03），未发现SP与任何变量有关。海平面本地人的ET水平较低（p = 0.04）。
肢体感觉异常与外周神经低ATPase有关。海平面本地人的ET水平较低可能反映了神经血管释放减少。
