Yang Ding-zhou, Zhou Qi-quan, Li Su-zhi, Zheng Bi-hai, Gao Yu-qi, Jiang Shao-hua, Huang Xue-wen
Department of High Altitude Disease, High Altitude Medicine College, Third Military Medical University, Chongqing 400038, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2009 Feb;21(2):95-8.
To investigate the relationship between gastrointestinal dysfunction (GD) and multiple organ dysfunction syndrome (MODS) in acute severe mountain sickness (ASMS), including high altitude pulmonary edema (HAPE), and high altitude cerebral edema (HACE), by a retrospective study of medical records and prospective study of hospitalized patients.
In retrospective study, the clinical data of 3 184 inpatients of General Hospital of Tibetan Military Command suffering from ASMS in the past 50 years (from June, 1958 to June, 2007) were collected. Statistical analysis was performed to study the relationship between GD and MODS in these patients. For the prospective study, 10 admitted patients of ASMS were included. Gastroscopic examination was performed for the ASMS patients, and gastric and duodenal mucosa was scrutinized. At the same time, 30 g of glutamine (Gln) capsule was orally ingested each day for 3 days after the first day of admission. Ten healthy volunteers were included in the control group, and received the same treatment. The levels of serum diamine oxidase (DAO), malonic dialdehyde (MDA), endotoxin and lactulose/mannitol (L/M) ratio were detected before and after treatment in two groups.
First, 49.8% of the patients with ASMS were complicated with GD, with 1.5% of fairy stool, and 1.0% with occult blood in stool. In 83 cases of ASMS complicated with MODS, 21.7% (18 cases) appeared GD, and the score of GD was 5.5 in the total score of all organ injury. Second, endoscopic examination showed extensive edema and localized hemorrhage in gastrointestinal mucous membrane, with dotted and patched erosion in gastric antrum and fundus. The pre-treatment DAO, MDA, and endotoxin were higher in the observation group than those in the control group (all P<0.01). After 3 days of Gln capsule treatment, DAO, MDA, and endotoxin were significantly decreased in the observation group (P<0.05 or P<0.01). The pre-treatment L/M ratio in observation group was significantly higher than that in healthy control group (150.69+/-19.91 vs. 117.91+/-17.78, P<0.01). The L/M ratio was significantly decreased after the treatment, as it decreased to 129.37+/-19.75 (P<0.05). However, no significant change in the healthy control group was observed.
GD plays a major role in the pathogenesis of MODS in ASMS patients.
通过对病历的回顾性研究和对住院患者的前瞻性研究，探讨急性重症高原病（ASMS，包括高原肺水肿（HAPE）和高原脑水肿（HACE））中胃肠功能障碍（GD）与多器官功能障碍综合征（MODS）之间的关系。
回顾性研究收集了西藏军区总医院过去50年（1958年6月至2007年6月）3184例ASMS住院患者的临床资料。进行统计分析以研究这些患者中GD与MODS的关系。前瞻性研究纳入10例ASMS住院患者。对ASMS患者进行胃镜检查，仔细观察胃和十二指肠黏膜。同时，入院第一天后每天口服30g谷氨酰胺（Gln）胶囊，共3天。对照组纳入10名健康志愿者，给予相同治疗。检测两组治疗前后血清二胺氧化酶（DAO）、丙二醛（MDA）、内毒素及乳果糖/甘露醇（L/M）比值水平。
首先，49.8%的ASMS患者合并GD，其中1.5%有稀便，1.0%粪便潜血阳性。在83例合并MODS的ASMS患者中，21.7%（18例）出现GD，在所有器官损伤总分中GD评分为5.5分。其次，内镜检查显示胃肠黏膜广泛水肿和局部出血，胃窦和胃底有散在点状和斑片状糜烂。观察组治疗前DAO、MDA和内毒素水平高于对照组（均P<0.01）。Gln胶囊治疗3天后，观察组DAO、MDA和内毒素显著降低（P<0.05或P<0.01）。观察组治疗前L/M比值显著高于健康对照组（150.69±19.91 vs. 117.91±17.78，P<0.01）。治疗后L/M比值显著降低，降至129.37±19.75（P<0.05）。然而，健康对照组未观察到显著变化。
GD在ASMS患者MODS的发病机制中起主要作用。
