内陆青年初入高原不同海拔血压变化及相关激素影响分析-现代医学

内陆青年初入高原不同海拔血压变化及相关激素影响分析

单位：1. 新乡医学院研究生学院, 河南新乡 453000;
2. 中国人民解放军陆军第八十三集团军医院血液内分泌科, 河南新乡 453000

关键词：高原|血压|影响因素|肾素-血管紧张素-醛固酮系统|下丘脑-垂体-甲状腺轴

分类号：R443.5;R82

出版年·卷·期（页码）：2025·53·第四期（602-608）

摘要：

目的： 研究内陆青年初入高原不同海拔血压及相关影响因素的变化情况。方法： 纳入长期内陆生活的健康青年男性500人，分别在平地、海拔2 700 m、3 600 m、4 300 m通过自制一般情况调查表及急性高原病(AMS)重症程度症状分度与评分量表、阿森斯失眠量表(AIS)、抑郁-焦虑-压力量表(DASS)进行评分。同时，定时测量基本生命体征(体温、脉搏、血压、血氧饱和度)并采集血样标本进行实验室检测激素水平。比较平地与4 300 m激素水平变化，统计不同海拔下其血压变化情况及相关影响因素。结果： (1)长期内陆生活的健康青年初入高原不同海拔高度地区后，随海拔升高脉搏逐渐加快，血氧饱和度逐渐降低，且海拔越高其下降幅度越明显。随海拔升高血压发生异常波动，总体呈上升趋势，血压异常发生率逐渐增高(包括高原高血压及高原低血压)，其中1级高血压发病率明显增加。(2)在海拔2 700 m、3 600 m、4 300 m时，AMS评分与血压异常发病率呈正相关，AIS、DASS评分无明显差异，但随海拔升高，睡眠障碍人群血压异常发生率明显高于无睡眠障碍人群。(3)高原地区测得血管紧张素Ⅱ、醛固酮、脑钠肽、甲状腺3项激素水平较平地时明显升高。结论： 内陆青年初入高原不同海拔血压及血压异常发生率与海拔高度成正相关。AMS评分、AIS评分对于评估高原血压异常有十分重要的价值。下丘脑-垂体-甲状腺轴及肾素-血管紧张素-醛固酮系统在高原环境下部分激素出现显著变化，可能在引起血压异常的发病机制中起着关键作用。

Objective: To investigate the changes in blood pressure and related influencing factors in inland young males upon initial exposure to high altitudes at different elevations. Methods: A total of 500 healthy young males who had lived in inland areas for a long time were included in the study. Assessments were conducted at plain level, 2 700 m, 3 600 m, and 4 300 m using a self-designed general information questionnaire, the Acute Mountain Sickness(AMS) scale, the Athens Insomnia Scale(AIS), and the Depression-Anxiety-Stress Scale(DASS). Basic vital signs(body temperature, pulse, blood pressure and oxygen saturation) were measured at regular intervals, and blood samples were collected for laboratory analysis of hormone levels. Hormonal changes at 4 300 m were compared with those at plain level, and blood pressure changes and related influencing factors at different altitudes were statistically analyzed.Results: (1) Upon initial exposure to high altitudes, healthy inland young males exhibited a gradual increase in pulse rate and a decrease in oxygen saturation as altitude increased, with the decline becoming more pronounced at higher altitudes. Blood pressure showed abnormal fluctuations, with an overall increasing trend, and the incidence of blood pressure abnormalities(including both high-altitude hypertension and hypotension) gradually increased, particularly with a significant rise in the incidence of stage 1 hypertension.(2) At altitudes of 2 700 m, 3 600 m, and 4 300 m, AMS scores were positively correlated with the incidence of blood pressure abnormalities. While AIS and DASS scores showed no significant differences, the incidence of blood pressure abnormalities was significantly higher in individuals with sleep disorders compared to those without, especially at higher altitudes.(3) Hormonal levels of angiotensin Ⅱ, aldosterone, brain natriuretic peptide, and thyroid-related hormones were significantly higher at high altitudes compared to plain level.Conclusion: The blood pressure and incidence of blood pressure abnormalities in inland young males upon initial exposure to high altitudes are positively correlated with altitude. AMS and AIS scores are valuable for assessing high-altitude blood pressure abnormalities. The hypothalamus-pituitary-thyroid axis(HPT) and the renin-angiotensin-aldosterone system(RAAS) exhibit significant hormonal changes in high-altitude environments, which may play a critical role in the pathogenesis of blood pressure abnormalities.

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