Hall David P, MacCormick Ian J C, Phythian-Adams Alex T, Rzechorzek Nina M, Hope-Jones David, Cosens Sorrel, Jackson Stewart, Bates Matthew G D, Collier David J, Hume David A, Freeman Thomas, Thompson A A Roger, Baillie John Kenneth
Royal Air Force Centre of Aviation Medicine, RAF Henlow, Beds, United Kingdom ; Apex (Altitude Physiology Expeditions), c/o Dr. J. K. Baillie, Critical Care Medicine, University of Edinburgh, Royal Infirmary of Edinburgh, United Kingdom.
Apex (Altitude Physiology Expeditions), c/o Dr. J. K. Baillie, Critical Care Medicine, University of Edinburgh, Royal Infirmary of Edinburgh, United Kingdom.
PLoS One. 2014 Jan 22;9(1):e81229. doi: 10.1371/journal.pone.0081229. eCollection 2014.
Acute mountain sickness (AMS) is a common problem among visitors at high altitude, and may progress to life-threatening pulmonary and cerebral oedema in a minority of cases. International consensus defines AMS as a constellation of subjective, non-specific symptoms. Specifically, headache, sleep disturbance, fatigue and dizziness are given equal diagnostic weighting. Different pathophysiological mechanisms are now thought to underlie headache and sleep disturbance during acute exposure to high altitude. Hence, these symptoms may not belong together as a single syndrome. Using a novel visual analogue scale (VAS), we sought to undertake a systematic exploration of the symptomatology of AMS using an unbiased, data-driven approach originally designed for analysis of gene expression. Symptom scores were collected from 292 subjects during 1110 subject-days at altitudes between 3650 m and 5200 m on Apex expeditions to Bolivia and Kilimanjaro. Three distinct patterns of symptoms were consistently identified. Although fatigue is a ubiquitous finding, sleep disturbance and headache are each commonly reported without the other. The commonest pattern of symptoms was sleep disturbance and fatigue, with little or no headache. In subjects reporting severe headache, 40% did not report sleep disturbance. Sleep disturbance correlates poorly with other symptoms of AMS (Mean Spearman correlation 0.25). These results challenge the accepted paradigm that AMS is a single disease process and describe at least two distinct syndromes following acute ascent to high altitude. This approach to analysing symptom patterns has potential utility in other clinical syndromes.
急性高原病（AMS）是高海拔地区游客常见的问题，少数情况下可能会发展为危及生命的肺水肿和脑水肿。国际共识将AMS定义为一组主观的、非特异性症状。具体而言，头痛、睡眠障碍、疲劳和头晕具有同等的诊断权重。现在认为，急性暴露于高海拔期间，头痛和睡眠障碍有着不同的病理生理机制。因此，这些症状可能并不属于单一综合征。我们使用一种新型视觉模拟量表（VAS），试图采用一种最初设计用于分析基因表达的无偏倚、数据驱动方法，对AMS的症状学进行系统探究。在前往玻利维亚和乞力马扎罗山的Apex探险中，在海拔3650米至5200米之间，共1110个受试者日，从292名受试者中收集了症状评分。一致识别出三种不同的症状模式。虽然疲劳是普遍存在的表现，但睡眠障碍和头痛通常各自单独出现。最常见的症状模式是睡眠障碍和疲劳，几乎没有或没有头痛。在报告严重头痛的受试者中，40%没有报告睡眠障碍。睡眠障碍与AMS的其他症状相关性较差（平均斯皮尔曼相关性为0.25）。这些结果挑战了AMS是单一疾病过程的公认范式，并描述了急性上升到高海拔后至少两种不同的综合征。这种分析症状模式的方法在其他临床综合征中具有潜在应用价值。
