Institute of Sport Sciences, Synathlon, Uni-Centre, Lausanne, Switzerland.
Department of Medical Research, Romandie Clinic for Rehabilitation, Sion, Switzerland.
High Alt Med Biol. 2019 Dec;20(4):344-351. doi: 10.1089/ham.2019.0035. Epub 2019 Jul 19.
Mechanisms underlying acute mountain sickness (AMS) remain unclear. Corticosteroids are effective for prevention and treatment suggesting a role for deficient endogenous cortisol. The cortisol awakening response (CAR), the increase in cortisol secretion over the first 30-45 minutes after morning awakening, better reflects the hypothalamic-pituitary-adrenal (HPA) axis than single cortisol measurements. We hypothesized that CAR may be altered in AMS-prone persons. Upon arrival at 4554 m (high altitude [HA]), 81 mountaineers agreed to participate. The following morning, they gave three saliva samples after awakening (S1: 0 minute, S2: 30 minutes, S3: 45 minutes). AMS was scored with the 1993 Lake Louise Score (LLS, cut-off ≥5). Minimally 4 weeks after descent, saliva was recollected by 58 of 81 participants at low altitude (LA); 382 ± 309 m, mean ± standard deviation). Cortisol was quantified by immunoassay. Three cortisol indices were analyzed: first sample on awakening (S1), CAR (area under curve with respect to S1) and total post awaking cortisol (area under the curve from ground [AUC-G]). AMS prevalence was 30%. At HA compared to LA, S1 (450 ± 190 vs. 288 ± 159 ng/dL, < 0.001) and AUC-G (387 ± 137 vs. 276 ± 114 ng/dL·min, < 0.001) were greater, but CAR was not (50 ± 100 vs. 60 ± 81 ng/dL·min, = 0.550). AMS+ compared to AMS- participants had higher S1 both at HA (495 ± 209 vs. 384 ± 176 ng/dL, = 0.016) and LA (354 ± 160 vs. 253 ± 142 ng/dL, = 0.015) and lower CAR at LA (24 ± 87 vs. 79 ± 72 ng/dL·min, = 0.013). AUC-G was similar in both groups at HA and LA. Some indices of salivary cortisol response upon awakening differ between AMS+ and AMS-, both at HA and LA, suggesting a link between HPA-axis homeostasis and AMS.
高山病（AMS）的发病机制尚不清楚。皮质类固醇对预防和治疗有效，这表明内源性皮质醇不足发挥了作用。皮质醇觉醒反应（CAR），即清晨觉醒后前 30-45 分钟内皮质醇分泌的增加，比单次皮质醇测量更能反映下丘脑-垂体-肾上腺（HPA）轴。我们假设 CAR 可能在易患 AMS 的人群中发生改变。
81 名登山者到达 4554 米（高海拔 [HA]）后，同意参与研究。第二天早上，他们在醒来后（S1：0 分钟，S2：30 分钟，S3：45 分钟）采集了三个唾液样本。AMS 的评分采用 1993 年路易斯湖评分（LLS，≥5 分为界）。至少在下降后 4 周，81 名参与者中的 58 名在低海拔（LA）采集唾液；382±309m，平均值±标准差）。皮质醇通过免疫测定法进行定量。分析了三个皮质醇指数：第一个样本在觉醒时（S1）、CAR（相对于 S1 的曲线下面积）和觉醒后总皮质醇（从地面开始的曲线下面积 [AUC-G]）。AMS 的患病率为 30%。与 LA 相比，HA 时 S1（450±190 vs. 288±159ng/dL， < 0.001）和 AUC-G（387±137 vs. 276±114ng/dL·min， < 0.001）更高，但 CAR 没有差异（50±100 vs. 60±81ng/dL·min， = 0.550）。与 AMS-参与者相比，AMS+参与者在 HA（495±209 vs. 384±176ng/dL， = 0.016）和 LA（354±160 vs. 253±142ng/dL， = 0.015）时的 S1 更高，而在 LA 时的 CAR 更低（24±87 vs. 79±72ng/dL·min， = 0.013）。HA 和 LA 时两组的 AUC-G 相似。在 HA 和 LA，AMS+和 AMS-之间，一些觉醒时唾液皮质醇反应的指数不同，这表明 HPA 轴稳态与 AMS 之间存在联系。
