二维脉冲多普勒对健康人初到高原心功能的评价

本文采用二维脉冲多普勒超声心动图仪记录了100例健康人由平原陆运到高原前后心脏各瓣口血流变化。其结果,进藏后主动脉瓣口血流速度比进藏前显著增快,而射血时间缩短;计算其每搏流速 积分无显著差异;由于进藏后心率明显增快,故每分输出量明显增加,二尖瓣口和三尖瓣口血流E峰速 进藏后明显减低,A/E比值明显增大,表明心脏舒张功能障碍,此外,肺动脉瓣口血流进藏后比进藏前加速时间明显缩短,减速 时间明显,证明初到高原即可出现肺动脉高压。     

急性高原病的预防性用药

急性高原病是暴露于高原时,因高原低氧而在数小时至数天内出现的临床症候群,若不及时诊治,会发展为较为严重的高原肺水肿和高原脑水肿。随着我国对西部地区投入力度的增加,内地人员进入高原地区日渐增多,因此如何保证进入高原的人员健康,是医药科研工作的一项重要任务。为使人们有效快速地预防急性高原病,本文对国内外使用较为普遍的药物以及它们的作用机制进行了概述;并对有良好应用前景的药物进行了介绍。     

急性高原病患者血清和支气管肺泡灌洗液炎性反应物的改变

目的：探讨炎症反应在急性高原病发病中的作用。方法：采用支气管-肺泡灌洗法及单向免疫扩散测量法。结果：HAPE患者外周血中C-反性蛋白及免疫球蛋白(IgG、IgA、IgM)含量均显著高于HAAR组及对照组,补体C3、C4与对照组差别无显著性;HAPE患者肺泡灌洗液中含有大量蛋白质、红细胞及白细胞,含有C-反应蛋白,大量的免疫球蛋白(IgG、IgA、IgM)和补体C3-C4。结论：在HAPE发病过程中,除了肺动脉高压是其发病的重要因素外,炎症损伤亦起一定作用;而HAAR发病过程中,未见炎性反应发生。     

急性高原病的预防性用药

急性高原病是暴露于高原时,因高原低氧而在数小时至数天内出现的临床症候群,若不及时诊治,会发展为较为严重的高原肺水肿和高原脑水肿。随着我国对西部地区投入力度的增加,内地人员进入高原地区日渐增多,因此如何保证进入高原的人员健康,是医药科研工作的一项重要任务。为使人们有效快速地预防急性高原病,本文对国内外使用较为普遍的药物以及它们的作用机制进行了概述;并对有良好应用前景的药物进行了介绍。     

急性高原病的遗传易感性

急性高原病(Acute high altitude disease, AHAD)分为急性高原反应、高原肺水肿和高原脑水肿, 是高原特发病之一, 在高原旅居者中(>2 500 m)具有高发生率, 不仅影响人们的工作能力和健康, 而且可能危及生命。尽管AHAD的相关研究已开展百余年, 其病理生理机制仍不明确, 但大量研究已证实AHAD存在易感性的差异。文章综述了迄今为止AHAD的遗传易感性研究进展, 以期为AHAD的流行病学研究提供有益的参考资料。     

定量蛋白质组学在急性高原病研究中的应用进展

急性高原病(acute mountain sickness,AMS)是人体急性暴露于高原低压低氧环境后出现多系统生理紊乱的临床综合征。定量蛋白质组学技术可以系统定量并描述机体蛋白质组成和动态变化规律,近年来在多种疾病的预防、诊断、治疗和发生机制等方面研究应用广泛。本文系统综述了定量蛋白质组学技术及其在AMS的预防、诊断、治疗和急进高原习服机制研究中的应用进展,以期为AMS的发病机制、提前干预、临床治疗和AMS的蛋白质组学研究提供参考。     

塔吉克族高原人群高尿酸血症与慢性高原病关系的探讨

目的：研究帕米尔高原地区血尿酸（SUA）水平与慢性高原病（CMS）的关系,为该地区CMS防治提供新策略。方法：以海拔、年龄、性别为匹配条件,进行1：1配对的病例对照研究,纳入30例通过国际CMS诊断记分系统确诊的CMS人群作为病例组,其中男性22例,女性8例,平均年龄为（41.87±6.05）岁。收集30例非CMS人群作为对照组,平均年龄为（41.37 ±5.54）岁,两组均为世居帕米尔高原塔吉克族。分析两组人群中体质指数、心率、血氧饱和度、SUA、血压及血脂的差异性。校正混杂因素后比较两组人群中SUA的差异,研究高尿酸血症（HUA）与CMS的关系。结果：病例组与对照组间人群的SUA、低密度脂蛋白（LDL-C）及载脂蛋白B （APOB）存在统计学差异（P<0.05）,校正混杂因素后,SUA是CMS的危险因素（OR：1.015,95% CI：1.004-1.026,P<0.01）。HUA在两组间的优势比为6.882（95% CI：1.707-27.7 52,P<0.01）。结论：SUA水平同CMS关系密切,HUA可能为塔吉克族高原人群CMS的一个危险因素。     

不同海拔高度对健康成年男性心脏血流动力学和心电图的影响

目的:监测中国南极冰盖考察预选队员心血管系统随海拔增高的变化,探讨筛查低氧易感队员和急性高原病的防治。方法:用无创血流动力学监护仪和十二导联心电图机,在北京(40 m)、拉萨(3 650 m)、羊八井(4 300 m)对第25次和26次南极冰盖考察预选队员心血管功能进行连续动态性监测。结果:随着海拔的增高,心率、收缩压、舒张压、平均动脉压、外周血管阻力、外周血管阻力指数显著升高(P0.05),心输出量、心指数、搏出量、搏出指数、加速度指数、速度指数、左心射血时间显著降低(P0.05),预射血期呈降低趋势(P0.05)。结论:随着海拔的增高,预选队员的外周血管阻力显著升高,左心泵血和收缩功能减弱且与Q-TC间期呈负相关。     

左心室脱血回注循环辅助法对急性心肌梗死血流动力学的改善作用

目的:实验观察左心室脱血回注循环辅助法对急性心肌梗死血流动力学的改善作用.方法:18只杂种犬分两组制作急性心肌梗死泵衰竭模型,治疗组给予左心室脱血回注循环辅助,对照组不进行治疗.观察比较两组间心律失常、死亡率、外周动脉压、肺动脉毛细血管楔嵌压(PCWP)、左心室舒张末期压(LVEDP)、左心室内径的变化.结果:治疗组室性期外收缩、心室纤颤发生率和死亡率显著低于对照组;对照组的外周动脉收缩压低于80 mmHg以下,治疗组维持在100mmHg以上(P＜0.01);治疗组PCWP和LVEDP值在45 min以后的各时段低于对照组(P＜0.01);治疗组的左室舒张末期内径小于对照组(P＜0.01).结论:左心室脱血回注循环辅助法能够减少急性心肌梗死泵衰竭的心室纤颤发生率和死亡率,有显著改善血流动力学、防止梗死后心肌扩张和有效的左心室辅助作用.     

高原人体左心室舒张功能和顺应性的改变

应用同步描记心电图、心音图、颈动脉搏动图和心尖搏动图以测定高原人体的左心室舒张功能和顺应性。在4个不同海拔高度进行实验,即76m(海平对照)、2161m、3270m和4179m,每一高度40名健康男性青年,高原3组世居、移居各20名。结果显示:随着海拔增高,主动舒张时间指数(TRTI)有减小趋势,RF波相对振幅(F/H)逐渐降低,A波相对振幅(A/D)则渐趋增大,3270m以上增大明显(p<0.05),舒张振幅时间指数(DATI)逐渐降低,3270m以上差异极显著(p<0.001)。高原世居与移居者相比,在海拔4179m出现明显差别,移居组TRTI、DATI、F/H较低而A/D较高(D<0.05)。测定射血前期与左室射血时间比值(PEP/LVET)、射血分数(EF)及左室周径纤维平均缩短速度(mVcf)3项指标作对照,显示在此高度左室收缩功能仍能保持。高原慢性心肌缺氧可能是导致左室舒张功能和顺应性轻度降低的原因。     

高原致适应剂新复方党参片预防急性高原反应的效果

目的:观察高原致适应剂新复方党参片对急性高原反应(AMS)的预防效果。方法:世居平原者驻守海拔1400m3个月的45名青年男性官兵,随机分为新复方党参片组(30人)和对照组(15人),采用单盲试验方法,于行军前5d开始分别口服新复方党参片和安慰剂片,乘车行军3d,于3700m习服4d,直至进驻高原(海拔5200m)第3天后停药,共服药15d。进驻高原后第1、3、5天,依国家军用标准GJB1098-91急性高原反应的诊断和处理原则,随访记录受试者的AMS症状,然后分度评分,检测受试者的心率(HR)、血氧饱和度(SaO2)。进驻高原后第6天,检测用力肺活量(FVC)、1秒用力呼气量(FEV1.0)、FEV1.0/FVC,一秒率(FEV1%)、最大呼气中期流速(FEF25%～75%)、呼气峰流速(PEF)、最大通气量(MVV)、左右手交叉敲击动作频率总次数(Ttis)、错误次数(Etis)、正确次数(Ctis)、平均时间(Atime)和数字记忆能力试验错误记忆次数总和(Sum)。结果:与对照组比较,进驻高原后第1、3、5d,新复方党参片组AMS症状显著减轻(P0.01);新复方党参片组与对照组的AMS程度分度分布不同(P0.01),新复方党参片组中症状较轻的(基本无反应、轻度反应)占比重较大,而对照组中症状较重的(中度反应、重度反应)占比重较大;新复方党参片组AMS发生率明显降低;与对照组比较,新复方党参片组的FVC、FEV1.0、FEF25%～75%、PEF、MVV升高有统计学意义(P0.05,P0.01),FEV1%差异无统计学意义;与对照组比较,新复方党参片组的Ttis、Ctis增加(P0.05,P0.01),Atime减少(P0.05),Etis和Sum差异无统计学意义。结论:新复方党参片能减轻AMS的程度,减轻AMS的症状,降低AMS发生率;并能显著改善受试者的肺通气功能和手指运动能力。     

低氧反应和屏气反应在急性高原反应预测中的作用

目的:探讨低氧反应和屏气反应在急性高原反应预测中的作用.方法:在平原观察113名入藏人员吸入10%低氧气体10 min和屏气过程中的血氧饱和度、心率和血压变化;进入高原后进行急性高原反应(AMS)症状评分;两组数据进行相关分析,并对急性高原反应者和基本无反应者数据进行分析.结果:吸入10%低氧气体过程中,动脉血氧饱和度进行性下降,心率迅速升高,血压普遍呈现先升高后降低的变化趋势.急性高原反应者吸入低氧气体1min时的心率明显慢于基本无反应者.所观测指标均存在着较大的个体差异,但相关分析表明,AMS评分仅与吸入低氧气体7 min时的心率呈显著负相关,相关系数r为-0.176.结论:在平原单纯用低氧和屏气反应来预测3 658 m高原地区的AMS发病情况意义可能有限.     

Effect of yogic exercises on thyroid function in subjects resident at sea level upon exposure to high altitude

Using radioactive iodine, the effect of 1 month's yogic exercises has been investigated on the thyroid function of subjects resident at sea level (SL) specially after their exposure to high altitude (HA). The results have been compared with a group of SL subjects who underwent physical training (PT) exercises for the same duration. Ten healthy male volunteers in the age range of 20–30 years were used as test subjects in this study with each serving as his own control. The subjects were randomly divided into two groups of 5 each. One group practised hatha yogic exercises, while the other group performed the regular PT exercises. The thyroidal accumulation and release of radioactive iodine have been measured in each of the subjects of both groups before and after 1 month of their respective exercises at SL. One month of yogic exercises at SL has been observed to cause a significant reduction in the trans-thy-roidal availability of radioiodine. The thyroid radioactivity in this group of subjects was always below normal levels with the exception of two peaks of radioactive iodine uptake, when the levels of radioactivity in the thyroid were similar to the control values of pre-yogic exercises. The release of radiolabel at 24–48 h was significantly increased after yogic exercises. In contrast, the subjects performing PT exercises for the same duration at SL showed significant thyroid uptake of radioactive iodine at 24 h. Subsequently their¹³¹I uptake continued to rise slowly until 72 h without any demonstrable thyroidal release of radiolabel. This indicated that increased thyroid activity was induced by conventional PT exercise. Exposure of SL residents to HA irrespective of their exercise regime altered the thyroidal handling of radioiodine. Thyroidal concentrations of freshly administered radioiodine at early and late sampling intervals were very high in both of the groups, especially the yogics, after their return to SL from HA. Possible mechanisms of the observed changes have been discussed.     

高原脑水肿患者血浆的蛋白质组学研究

目的：高原脑水肿是急性高原病的重症表现之一,其发病机制尚不完全清楚。本实验目的是应用蛋白质组学方法研究高原脑水肿发病时血浆蛋白质表达的变化,为研究高原脑水肿发病分子机制以及高原脑水肿的预防、诊断及治疗提供重要的分子标志物。方法：应用二维凝胶电泳（2D）结合质谱的方法比较了一例高原脑水肿（HACE）患者与高原肺水肿（HAPE）和轻型急性高原反应（mAMS）患者血浆蛋白表达的差异,对差异蛋白进行鉴定,最后用ELISA方法检测载脂蛋白E含量。结果：我们检测到HACE与HAPE患者血浆比较有6个差异蛋白质点,HACE与mAMS患者血浆比较也有6个差异蛋白质点,质谱鉴定结果显示两组比较中都有载脂蛋白E含量变化,ELISA检测结果与二维凝胶电泳结果一致。结论：本实验首次将蛋白质组学技术应用到高原脑水肿研究中,并且发现了可能与高原脑水肿发病密切相关的载脂蛋白E,该蛋白对于研究高原脑水肿发病分子机制以及疾病的预防、诊断及治疗的意义有待进一步研究。     

氨茶碱及硝苯吡啶治疗高原肺水肿效果观察

目的:评价氨茶碱及硝苯吡啶对高原肺水肿的疗效.方法:采用右心漂浮导管方法,观察了静脉推注氨茶碱及舌下含服硝苯吡啶对患者血流动力学及动脉血气等方面的影响.结果:氨茶碱能降低患者的肺动脉压和肺血管阻力,提高患者的心输出量及动脉血氧饱和度,用药前后体循环压及心率未见明显变化.硝苯吡啶含服也能降低肺动脉压和肺血管阻力,虽能降低体循环压但幅度较小,但用药前后心输出量、心率及动脉血气饱和度未见明显变化.结论:氨茶碱及硝苯吡啶均有急性降低高原肺水肿患者肺动脉高压的作用,但二者相比,氨茶碱降低肺动脉压效果明显优于硝苯吡啶.     

Myocardial fibrosis and right ventricular function of heterotopically transplanted hearts in rats treated with cyclosporin

The aim was to determine whether treatment of rats with cyclosporin A (CsA) leads to deleterious side effects on heterotopically iso- or allotransplanted hearts when compared with recipient native in situ hearts. Four experimental groups were employed: inbred (Lewis) rats receiving either no immunosuppression or CsA at a dose of 15 mg.kg^–1 per day for 7 days after surgery, and outbred (Wistar) rats receiving CsA at the same daily dose for either 7 or 21 days. One month following surgery, the mass of all transplanted hearts decreased and resulting atrophy was associated with relative myocardial fibrosis. Treatment with CsA significantly increased the concentration and content of collagen in the right and left ventricles of all transplanted and recipient hearts. No appreciable difference was observed between corresponding hearts of inbred and outbred groups receiving the identical dose of CsA, and between hearts in outbred groups treated for either 7 or 21 days. No signs of right ventricular mechanical dysfunction, as assessed on the isolated perfused working preparation, were observed after CsA treatment in both transplanted and recipient hearts. The maximal steady state developed pressure (RVDevP) and the rate of its development [(+dP/dt)_max] were slightly higher in transplants than in the corresponding recipients, and in CsA-treated versus untreated hearts, while the index of contractile state [(+dP/dt)/P] was similar in all groups. The data suggest that treatment of rats with CsA can induce a similar degree of fibrosis both in heterotopic cardiac transplants and in recipient native hearts without impairment of their contractile performance.     

Brazilian Páramos II. Macro- and mesoclimate of the campos de altitude and affinities with high mountain climates of the tropical Andes and Costa Rica

Aim This paper presents a basic analysis of the macro- and mesoclimate of the Brazilian campos de altitude, a series of cool–humid, mountaintop grasslands in southeastern Brazil, and compares results with data from other tropical as well as temperate alpine sites. Location Beginning at altitudes of 1800–2000 m, the campos de altitude are found atop the highest summits of the main ranges of the southeastern Brazilian Highlands, between the states of Santa Catarina and Minas Gerais/Espírito Santo. Methods Macro- and mesoclimatic parameters for the campos de altitude are derived from both original data and previously reported results. Parameters include approximate radiation budgets, temperature lapse rates, seasonal and diurnal patterns in temperature, occurrence of frost, elevational gradients in precipitation, and interannual and seasonal patterns in precipitation. Using multivariate techniques and simple numerical contrasts, the climate of the campos de altitude is compared to climates of other tropical as well as temperate alpine sites. Results With respect to patterns of seasonality and the marked influence of polar frontal activity, the macroclimate of the campos de altitude is typically tropical-marginal. However, in reference to actual temperature and precipitation values, the length and profundity of the dry season, average humidities and cloudiness, the climate of the campus de altitude more closely corresponds to that of more inner-tropical systems. These commonalities are best developed with respect to páramo climates of the northern Andes and, especially, Costa Rica. Main conclusions Their very different latitudinal and geographic positions notwith- standing, the campos de altitude and high mountain formations of the N. Andean and Central American Cordillera show clear macroclimatic congruities. In these congruities reside both the environmental basis for strong Andean–southeast Brazilian biogeographic connections, and the context within which evolutionary and ecological parallelisms have developed in the biota of these two widely separate neotropical mountain systems.     

缬沙坦联合培哚普利对慢性心力衰竭患者心功能及血浆BNP、CRP、IL-6

目的：观察缬沙坦联合培哚普利对慢性-22力衰竭（CHF）的治疗效果,以及对患者心功能、血浆脑利钠肽（BNP）、c反应蛋白（CRP）和IL-6的影响。方法：95例CHF患者随机分为缬沙坦治疗组（30例）、培哚普利治疗组（30例）和联合治疗组（35例）,患者均予以常规西医治疗,缬沙坦治疗组或培哚普利治疗组在常规治疗基础上加用缬沙坦或培哚普利,联合治疗组则同时加用缬沙坦和培哚普利。观察治疗效果及患者心功能变化,检测治疗前后血浆BNP、CRP、IL-6的浓度。结果：联合治疗组总有效率达到91．43％,高于缬沙坦治疗组73．33％和培哚普利53．33％的总有效率（P〈0．05）;与缬沙坦治疗组和培哚普利治疗组相比,缬沙坦联合培哚普利可有效改善患者心功能指标,降低血浆BNP、CRP、IL-6含量。结论：缬沙坦联合培哚普利能有效改善心功能,调节细胞因子表达,优于单用缬沙坦或培哚普利治疗。     

缬沙坦联合培哚普利对慢性心力衰竭患者心功能及血浆BNP、CRP、IL-6 的影响

目的:观察缬沙坦联合培哚普利对慢性心力衰竭(CHF)的治疗效果,以及对患者心功能、血浆脑利钠肽(BNP)、C反应蛋白(CRP)和IL-6的影响。方法:95例CHF患者随机分为缬沙坦治疗组(30例)、培哚普利治疗组(30例)和联合治疗组(35例),患者均予以常规西医治疗,缬沙坦治疗组或培哚普利治疗组在常规治疗基础上加用缬沙坦或培哚普利,联合治疗组则同时加用缬沙坦和培哚普利。观察治疗效果及患者心功能变化,检测治疗前后血浆BNP、CRP、IL-6的浓度。结果:联合治疗组总有效率达到91.43%,高于缬沙坦治疗组73.33%和培哚普利53.33%的总有效率(P<0.05);与缬沙坦治疗组和培哚普利治疗组相比,缬沙坦联合培哚普利可有效改善患者心功能指标,降低血浆BNP、CRP、IL-6含量。结论:缬沙坦联合培哚普利能有效改善心功能,调节细胞因子表达,优于单用缬沙坦或培哚普利治疗。