王泽军 刘运胜 谭敏 薛锐

[摘要] 目的 分析急進高原后人外周血红细胞形态及血管内皮功能变化，为急性高原病（AMS）的预防和治疗提供参考。 方法 于2015年8月～2017年10月选取重庆地区拟急进高原的195名健康男性受试者，抽取其急进高原前（海拔500 m）及急进高原后（海拔3500 m）外周血10 mL，对其红细胞形态、血管内皮功能进行检测。按照受试者AMS发生情况，将其分为发生组、未发生组，对两组受试者外周血红细胞形态、血管内皮功能进行比较。 结果 急进高原后，受试者正常形态红细胞数量、血清一氧化氮（NO）均下降，其血清内皮素1（ET-1）、血管内皮生长因子（VEGF）、血管性血友病因子（vWF）均上升，差异均有统计学意义（P < 0.05）。共有48名受试者发生AMS，发生率为24.62%。急进高原后，两组正常形态红细胞数量均下降，血清ET-1均上升，发生组上述变化较未发生组更为明显，差异均有统计学意义（P < 0.05）；发生组NO低于急进高原前，VEGF、钙黏蛋白、vWF高于急进高原前，差异均有统计学意义（P < 0.05）。 结论 急进高原后人外周血红细胞趋于畸形化改变并伴有血管内皮功能受损，上述生理改变的进展可能是AMS发生的重要原因。

[关键词] 急进高原；外周血；红细胞形态；血管内皮功能

[中图分类号] R82 [文献标识码] A [文章编号] 1673-7210（2018）10（b）-0112-04

[Abstract] Objective To analyze the changes of erythrocyte morphology and vascular endothelial function in human peripheral blood after rushing into plateau， so as to provide references for prevention and treatment of acute mountain sickness （AMS）. Methods From August 2015 to October 2017， a total of 195 healthy male objects going to rush into plateau in Chongqing were selected and 10 mL of peripheral blood was extracted before rushing into plateau （altitude 500 m） and after rushing into plateau （altitude 3500 m） to detect their erythrocyte morphology and vascular endothelial function. According to the occurrence of AMS， they were divided into occurrence group and non-occurrence group. The erythrocyte morphology and vascular endothelial function of the two groups were compared. Results After rushing into plateau， the number of normal red blood cells and serum nitric oxide （NO） of the objects decreased， the serum endothelin-1 （ET-1）， vascular endothelial growth factor （VEGF） and von Willebrand factor （vWF） increased， the differences were statistically significant （P < 0.05）. A total of 48 objects developed AMS， the incidence of which was 24.62%. After rushing into plateau， the number of normal forms of red blood cells in the two groups decreased， and the serum ET-1 increased， the above changes of occurrence group were more obvious than non-occurrence group， the differences were statistically significant （P < 0.05）. As for occurrence group， the NO was lower than that before rushing into plateau， and VEGF， calcium mucin and vWF were higher than those before rushing into plateau， the differences were statistically significant （P < 0.05）. Conclusion The peripheral blood erythrocytes tend to change deformities and the vascular endothelial function is impaired. The progress of these physiological changes may be an important cause of the occurrence of AMS.

[Key words] Rush into plateau； Peripheral blood； Erythrocyte morphology； Vascular endothelial function

急性高原病（acute mountain sickness，AMS）通常发生于从平原快速进入高原或由较低海拔快速到达高海拔地区的人群，患者症状以心慌、气短、头痛、呕吐、睡眠障碍为主，严重者可发生高原肺水肿甚至脑水肿，生存质量受到一定威胁[1]。随着高原开发建设的加速，我国急进高原人群数量逐年增多，AMS的防治得到了越来越多的重视，而过往关于AMS的研究多集中于药物预防和治疗环节，对于其发病机制的探讨较为有限[2]。有研究发现，AMS发生后，机体可代偿性产生大量红细胞，并伴有血管内皮细胞多种低氧代偿机制的启动[3]，故本研究自外周血红细胞形态及血管内皮功能变化入手，旨在进一步了解AMS发生机制，为AMS的防治提供新的思路。……