Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China.
Chin Med Sci J. 2020 Mar 31;35(1):13-19. doi: 10.24920/003552.
Objective To examine if the variations at sea level would be able to predict subsequent susceptibility to acute altitude sickness in subjects upon a rapid ascent to high altitude. Methods One hundred and six Han nationality male individuals were recruited to this research. Dynamic electrocardiogram, treadmill exercise test, echocardiography, routine blood examination and biochemical analysis were performed when subjects at sea level and entering the plateau respectively. Then multiple regression analysis was performed to construct a multiple linear regression equation using the Lake Louise Score as dependent variable to predict the risk factors at sea level related to acute mountain sickness (AMS). Results Approximately 49.05% of the individuals developed AMS. The tricuspid annular plane systolic excursion (22.0±2.66 . 23.2±3.19 mm, =1.998, =0.048) was significantly lower in the AMS group at sea level, while count of eosinophil [(0.264±0.393)×10/L . (0.126±0.084)×10/L, =-2.040, =0.045], percentage of differences exceeding 50 ms between adjacent normal number of intervals (PNN50, 9.66%±5.40% . 6.98%±5.66%, =-2.229, =0.028) and heart rate variability triangle index (57.1±16.1 . 50.6±12.7, =-2.271, =0.025) were significantly higher. After acute exposure to high altitude, C-reactive protein (0.098±0.103 . 0.062±0.045 g/L, =-2.132, =0.037), aspartate aminotransferase (19.7±6.72 . 17.3±3.95 U/L, =-2.231, =0.028) and creatinine (85.1±12.9 . 77.7±11.2 mmol/L, =-3.162, =0.002) were significantly higher in the AMS group, while alkaline phosphatase (71.7±18.2 . 80.6±20.2 U/L, =2.389, =0.019), standard deviation of normal-to-normal RR intervals (126.5±35.9 . 143.3±36.4 ms, =2.320, =0.022), ejection time (276.9±50.8 . 313.8±48.9 ms, =3.641, =0.001) and heart rate variability triangle index (37.1±12.9 . 41.9±11.1, =2.020, =0.047) were significantly lower. Using the Lake Louise Score as the dependent variable, prediction equation were established to estimate AMS: Lake Louise Score=3.783+0.281×eosinophil-0.219×alkaline phosphatase+0.032×PNN50. Conclusions We elucidated the differences of physiological variables as well as noninvasive cardiovascular indicators for subjects after high altitude exposure compared with those at sea level. We also created an acute high altitude reaction early warning equation based on the physiological variables and noninvasive cardiovascular indicators at sea level.
目的 探讨海平面的变化是否能够预测受试者快速上升到高海拔后对急性高原病的易感性。 方法 本研究招募了 106 名汉族男性。受试者分别在海平面和高原时进行动态心电图、跑步机运动试验、超声心动图、常规血液检查和生化分析。然后使用洛矶山评分作为因变量，进行多元线性回归分析，构建一个多元线性回归方程，预测与急性高原病（AMS）相关的海平面风险因素。 结果 约 49.05%的个体发生了 AMS。在海平面时，AMS 组的三尖瓣环平面收缩期位移（22.0±2.66 . 23.2±3.19 mm，=1.998，=0.048）显著降低，而嗜酸性粒细胞计数[（0.264±0.393）×10/L. （0.126±0.084）×10/L，=-2.040，=0.045]、相邻正常间期差异超过 50 ms 的百分比（PNN50，9.66%±5.40%. 6.98%±5.66%，=-2.229，=0.028）和心率变异性三角指数（57.1±16.1. 50.6±12.7，=-2.271，=0.025）显著升高。急性暴露于高海拔后， C 反应蛋白（0.098±0.103. 0.062±0.045 g/L，=-2.132，=0.037）、天门冬氨酸氨基转移酶（19.7±6.72. 17.3±3.95 U/L，=-2.231，=0.028）和肌酐（85.1±12.9. 77.7±11.2 mmol/L，=-3.162，=0.002）显著升高，而碱性磷酸酶（71.7±18.2. 80.6±20.2 U/L，=2.389，=0.019）、正常-正常 RR 间期标准差（126.5±35.9. 143.3±36.4 ms，=2.320，=0.022）、射血时间（276.9±50.8. 313.8±48.9 ms，=3.641，=0.001）和心率变异性三角指数（37.1±12.9. 41.9±11.1，=2.020，=0.047）显著降低。使用洛矶山评分作为因变量，建立了估计 AMS 的预测方程：洛矶山评分=3.783+0.281×嗜酸性粒细胞-0.219×碱性磷酸酶+0.032×PNN50。 结论 我们阐明了受试者高原暴露后与海平面相比生理变量和无创心血管指标的差异。我们还基于海平面的生理变量和无创心血管指标建立了急性高原反应预警方程。
