Penaloza Dante, Arias-Stella Javier
Department of Medicine, Faculty of Medicine, University Cayetano Heredia, Lima, Peru.
Circulation. 2007 Mar 6;115(9):1132-46. doi: 10.1161/CIRCULATIONAHA.106.624544.
More than 140 million people worldwide live >2500 m above sea level. Of them, 80 million live in Asia, and 35 million live in the Andean mountains. This latter region has its major population density living above 3500 m. The primary objective of the present study is to review the physiology, pathology, pathogenesis, and clinical features of the heart and pulmonary circulation in healthy highlanders and patients with chronic mountain sickness. A systematic review of worldwide literature was undertaken, beginning with the pioneering work done in the Andes several decades ago. Original articles were analyzed in most cases and English abstracts or translations of articles written in Chinese were reviewed. Pulmonary hypertension in healthy highlanders is related to a delayed postnatal remodeling of the distal pulmonary arterial branches. The magnitude of pulmonary hypertension increases with the altitude level and the degree of exercise. There is reversal of pulmonary hypertension after prolonged residence at sea level. Chronic mountain sickness develops when the capacity for altitude adaptation is lost. These patients have moderate to severe pulmonary hypertension with accentuated hypoxemia and exaggerated polycythemia. The clinical picture of chronic mountain sickness differs from subacute mountain sickness and resembles other chronic altitude diseases described in China and Kyrgyzstan. The heart and pulmonary circulation in healthy highlanders have distinct features in comparison with residents at sea level. Chronic mountain sickness is a public health problem in the Andean mountains and other mountainous regions around the world. Therefore, dissemination of preventive and therapeutic measures is essential.
全球有超过1.4亿人生活在海拔2500米以上的地区。其中，8000万人生活在亚洲，3500万人生活在安第斯山脉。后一地区的主要人口密集区生活在海拔3500米以上。本研究的主要目的是综述健康高原居民和慢性高原病患者心脏与肺循环的生理学、病理学、发病机制及临床特征。我们对全球文献进行了系统综述，始于几十年前在安第斯山脉开展的开创性工作。多数情况下分析原创文章，并对英文摘要或中文撰写文章的译文进行了综述。健康高原居民的肺动脉高压与出生后远端肺动脉分支的重塑延迟有关。肺动脉高压的程度随海拔高度和运动程度增加。长期居住在海平面后，肺动脉高压会逆转。当失去海拔适应能力时，就会发展为慢性高原病。这些患者患有中度至重度肺动脉高压，伴有加重的低氧血症和红细胞增多症。慢性高原病的临床表现与亚急性高原病不同，类似于中国和吉尔吉斯斯坦描述的其他慢性高原病。与海平面居民相比，健康高原居民的心脏和肺循环具有明显特征。慢性高原病是安第斯山脉和世界其他山区的一个公共卫生问题。因此，传播预防和治疗措施至关重要。
