平原动脉血压对急性高原病易感性的预测

摘要

目的：研究健康青年男性平原动脉血压与暴露于高原急性高原病易感性之间的关系，旨在评价动脉血压测量在急性高原病（ AMS）诊断中的作用。方法由平原乘飞机急进入高原男性青年中随机抽取204例，对其进行一般检查，项目包括动脉血压测量、AMS流行病学观察表（包括人群一般人口学资料）填写。①测定海拔为平原（500 m）、高原（3700 m）第1天；②用路易斯湖评分系统（ LLS）进行AMS诊断，有头痛且评分％≥3诊断为AMS。比较急进高原（3700 m）第1天AMS组和无AMS组平原动脉血压相关指标。用Pearson积矩相关分析对LLS评分与平原动脉血压各指标相关性作出判断，并通过ROC曲线作出其相应界值。结果①由平原急进高原（3700 m）第1天AMS发病率明显较高，达53．92％，且平原AMS评分明显较急进高原（3700 m）低（P＜0．05）。②急进高原（3700 m）第1天，AMS组舒张压（ DBP）、平均动脉压（ MABP）较无AMS组高，且两组间差异均有统计学意义（ P＜0．05），并通过Logistic回归分析筛选出DBP作为高原（3700 m） AMS发病客观评估指标，其诊断AMS界值为72．5 mmHg，灵敏度为56．3％，特异度为63．2％，曲线下面积（AUC）为0．598，P＜0．05。结论①暴露于高原后AMS发病明显升高。②平原DBP可能与AMS发病有关，且与LLS呈正相关，对高原AMS发病具有一定预测价值，但由于其特异性或敏感性问题，在实际应用中存在一定限制，应当与其他指标一起综合考虑预测AMS易感性，则可靠性会更准确。%Objective To explore that whether the normoxic low altitude measurement of arterial blood pressure would predict subsequent susceptibility to acute mountain sickness ( AMS) during rapid ascent to high altitude .Methods Arterial blood pressure ( using a wrist sphygmomanometer ) was determined in two hundred and four healthy lowlanders first exposed to 3700 m-altitude (Lhasa) from plain (500 m) by air, and the Lake Louise self-report questionnaire(LLS) was used to assess AMS.We compared the low altitude blood pressure related indicators of two groups ( AMS and non-AMS ) and analyzed the relationship of diagnostic score and blood pressure related indicators .Results ①The incidence of AMS in the selected subjects was 53.92% by LLS.AMS scores increased markedly at high-altitude (P<0.05 versus low altitude).②Diastolic blood pressure (DBP) and mean arterial BP (MABP) in the AMS group were higher than those in the non-AMS group(P<0.05).The low altitude DBP levels for diagnosis of AMS at high-altitude (3700 m) had an area under curve(AUC) =0.598, P<0.05, with sensitivity of 56.3%, specificity of 63.2%, and cut-off point of 72.5 mmHg. Conclusion ①After acute exposure to high altitude , the incidence of AMS increases significantly .②A higher baseline DBP may be considered a potential risk factor for AMS , and is positively associated with LLS .DBP may serve as a predic-tive parameter for diagnosis of AMS .However , the clinical application of DBP as a predictive criterion is limited because of its poor specificity or sensitivity .The use of DBP as a predictive criterion should be combined with other indicators for the better predictive value of AMS .