在低海拔地区运动后的生理反应与上升时急性高原病之间的关联具有性别依赖性。
Association between physiological responses after exercise at low altitude and acute mountain sickness upon ascent is sex-dependent.
机构信息
Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.
Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.
出版信息
Mil Med Res. 2020 Nov 5;7(1):53. doi: 10.1186/s40779-020-00283-3.
BACKGROUND
Acute mountain sickness (AMS) is the mildest form of acute altitude illnesses, and consists of non-specific symptoms when unacclimatized persons ascend to elevation of ≥2500 m. Risk factors of AMS include: the altitude, individual susceptibility, ascending rate and degree of pre-acclimatization. In the current study, we examined whether physiological response at low altitude could predict the development of AMS.
METHODS
A total of 111 healthy adult healthy volunteers participated in this trial; and 99 (67 men and 32 women) completed the entire study protocol. Subjects were asked to complete a 9-min exercise program using a mechanically braked bicycle ergometer at low altitude (500 m). Heart rate, blood pressure (BP) and pulse oxygen saturation (SpO) were recorded prior to and during the last minute of exercise. The ascent from 500 m to 4100 m was completed in 2 days. AMS was defined as ≥3 points in a 4-item Lake Louise Score, with at least one point from headache wat 6-8 h after the ascent.
RESULTS
Among the 99 assessable subjects, 47 (23 men and 24 women) developed AMS at 4100 m. In comparison to the subjects without AMS, those who developed AMS had lower proportion of men (48.9% vs. 84.6%, P < 0.001), height (168.4 ± 5.9 vs. 171.3 ± 6.1 cm, P = 0.019), weight (62.0 ± 10.0 vs. 66.7 ± 8.6 kg, P = 0.014) and proportion of smokers (23.4% vs. 51.9%, P = 0.004). Multivariate regression analysis revealed the following independent risks for AMS: female sex (odds ratio (OR) =6.32, P < 0.001), SpO change upon exercise at low altitude (OR = 0.63, P = 0.002) and systolic BP change after the ascent (OR = 0.96, P = 0.029). Women had larger reduction in SpO after the ascent, higher AMS percentage and absolute AMS score. Larger reduction of SpO after exercise was associated with both AMS incidence (P = 0.001) and AMS score (P < 0.001) in men but not in women.
CONCLUSIONS
Larger SpO reduction after exercise at low altitude was an independent risk for AMS upon ascent. Such an association was more robust in men than in women.
TRIAL REGISTRATION
Chinese Clinical Trial Registration, ChiCTR1900025728 . Registered 6 September 2019.
背景
急性高山病（AMS）是急性高原病中最轻微的形式，当未适应的人上升到≥2500 米的海拔时，会出现非特异性症状。AMS 的危险因素包括：海拔、个体易感性、上升速度和预适应程度。在目前的研究中，我们研究了低海拔时的生理反应是否可以预测 AMS 的发生。
方法
共有 111 名健康成年志愿者参加了这项试验；其中 99 人（67 名男性和 32 名女性）完成了整个研究方案。要求受试者在低海拔（500 米）下使用机械制动自行车测力计进行 9 分钟的运动。在运动前和运动最后一分钟记录心率、血压（BP）和脉搏血氧饱和度（SpO）。从 500 米上升到 4100 米用 2 天完成。AMS 定义为 Lake Louise 评分的 4 项中有≥3 分，至少有 1 分是在上升后 6-8 小时出现头痛。
结果
在 99 名可评估的受试者中，有 47 名（23 名男性和 24 名女性）在 4100 米处出现 AMS。与无 AMS 的受试者相比，出现 AMS 的受试者中男性比例较低（48.9%比 84.6%，P<0.001）、身高（168.4±5.9 厘米比 171.3±6.1 厘米，P=0.019）、体重（62.0±10.0 千克比 66.7±8.6 千克，P=0.014）和吸烟比例较低（23.4%比 51.9%，P=0.004）。多变量回归分析显示，以下是 AMS 的独立危险因素：女性（比值比（OR）=6.32，P<0.001）、低海拔运动时 SpO 变化（OR=0.63，P=0.002）和上升后收缩压变化（OR=0.96，P=0.029）。女性在上升后 SpO 下降更大，AMS 发生率和绝对 AMS 评分更高。运动后 SpO 下降与 AMS 发生率（P=0.001）和 AMS 评分（P<0.001）均相关，但与女性无关。
结论
低海拔运动后 SpO 下降更大是上升时 AMS 的独立危险因素。这种关联在男性中比女性更明显。
试验注册
中国临床试验注册中心，ChiCTR1900025728。注册日期：2019 年 9 月 6 日。
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