Koyama S, Kobayashi T, Kubo K, Fukushima M, Yoshimura K, Shibamoto T, Kusama S
First Department of Internal Medicine, Shinshu University School of Medicine, Japan.
Jpn J Med. 1988 Feb;27(1):10-6. doi: 10.2169/internalmedicine1962.27.10.
To assess the role of catecholamines in the pathogenesis of high altitude pulmonary edema (HAPE), 24-hour urinary catecholamine excretions and plasma catecholamine concentrations were measured. We also performed brain computed tomography (CT) in the same 8 serial patients with HAPE. 24-hour urinary norepinephrine excretion showed a statistically high value on admission compared with that after recovery (396.9 +/- 92.9 micrograms/24 hr, decreasing to 93.0 +/- 31.1 micrograms/24 hr, mean +/- S.E., p less than 0.01). 24-hour urinary epinephrine excretion on admission was also remarkably high, and returned later normal (62.9 +/- 25.8 micrograms/24 hr, decreasing to 12.7 +/- 4.2 micrograms/24 hr, p less than 0.05). Plasma norepinephrine concentration was also high, but returned to normal (0.260 +/- 0.073 ng/ml, to 0.11 +/- 0.043 ng/ml) by the time of discharge. Brain CT scans revealed diffuse low density of the entire cerebrum, small ventricles, disappearance of sulci, and small cistern, suggesting cerebral edema. These findings may suggest that the heightened sympathoadrenal activity that occurred in the patients concomitant with cerebral edema was related to the high altitude illness rather than to simple exposure to high altitude.
为评估儿茶酚胺在高原肺水肿（HAPE）发病机制中的作用，对24小时尿儿茶酚胺排泄量和血浆儿茶酚胺浓度进行了测定。我们还对8例连续性HAPE患者进行了脑部计算机断层扫描（CT）。与恢复后相比，入院时24小时尿去甲肾上腺素排泄量具有统计学意义的高值（396.9±92.9微克/24小时，降至93.0±31.1微克/24小时，均值±标准误，p<0.01）。入院时24小时尿肾上腺素排泄量也显著升高，随后恢复正常（62.9±25.8微克/24小时，降至12.7±4.2微克/24小时，p<0.05）。血浆去甲肾上腺素浓度也升高，但出院时恢复正常（0.260±0.073纳克/毫升，至0.11±0.043纳克/毫升）。脑部CT扫描显示整个大脑弥漫性低密度、脑室小、脑沟消失和脑池小，提示脑水肿。这些发现可能表明，患者出现的伴有脑水肿的交感肾上腺活动增强与高原病有关，而非单纯与暴露于高海拔环境有关。
