第十二届国际高原医学大会报告摘要选登

3869(大会论文编号)

CEREBROVASCULARREACTIVITYINHEALTHYADULTSAFTERRAPIDASCENTTOHIGHALTITUDE

LIU Jie，WU Shi-zheng

Qinghai Provincial People′s Hospital，Xining，China

A total of 59 subjects were divided into three groups.The low- altitude group(Beijing，44.4m)ascended rapidly to an intermediate-altitude area(Xining，2200m)，and various in dicators were measured before departure and 24 hours after arrival.After having rested for 48 hours，the low-altitude group，together with the intermediate-altitude group，as cended rapidly to a high-altitude area(Yushu，3700m)，and various indicators were measured 24 and 48 hours after arrival.In the low-altitude group，the CRV and cerebrovascular PUTEreserve index significantly increased，but the rScO2，significantly decreased after rapid ascent to the high altitude(P<0.001).Compared with the preascent levels，the serum vasoactive substances of nitric oxide(NO)，endothelial nitric oxide synthase (NOS)，erythropoietin，vascular endothelial growth factor，and soluble vascular endothelial growth factor receptor had been decreased in the low-altitude group after rapid ascent to high altitude(P<0.001).In the intermediate-altitude group，the CRV and the CVRI significantly increased after rapid ascent to the high-altitude area(P<0.001)，but the.rScO2slightly decreased(P<0.001).Among these three groups，CRV was negatively correlated with rScO2，highly positively correlated with NO and NOS.rScO2was highly positively correlated with red blood cell，HB，and vascular endothelial growth factor and moderately negatively correlated with NO and NOS.These changes reflect the hypoxia of local brain tissue in subjects at high altitude.

Keywords：acute hypoxia；cerebrovascular reactivity；rapidascent to high altitude；regional cerebral oxygen saturation；vasoactive substances

3891

INHIBITIONOFSUICIDALERYTHROCYTEDEATHBYCHRONICHYPOXIA

TANG Feng

Qinghai University，Xining，China

Background/Aims：Hig-altitude polycythemia(HAPC)is defined by the increase of hematocrit and hemoglobin at high altitude.It is widely considered that excessive erythrocytes production leads to HAPC.Eryptosis is a process by which mature erythrocytes undergo self-destruction，sharing several characteristics with apoptosis.Eryptosis in high-altitude hypobaric hypoxia is unknown.The purpose of this study was to test whether chronic hypoxia influences eryptosis and，if so，to shed light on the mechanisms.

Methods：Biotin labeling and flow cytometry were employed to evaluate the volume of mature erythrocytes from for ward scatter，phosphatidylserine scrambling from annexin-V binding，intracellular Ca2+from Fluo-3-AM，reactive oxygen species(ROS)abundance from ROS probe，ceramide，and CD47 abundance utlizing specific antibodies.

Results：The volume was changed and percentage of annexin-V-binding cells was sigificantly decreased underchronic hypobaric hypoxia and the biotin-positive RBCs were increased in chronic hypoxia group. Furhermore，chronic hypoxia increased CD47 and ceramide abundance and decreased intracellular Ca2+but has on ROS formation.

Conclusions：Chronic hypobaric hypoxia inhibits eryptosis through decreasing intracellular Ca2+and increasing integrin-associated protein CD47.

3935

STUDIESONAPOPTOSIS，CYTOCHROMEC，ANDMITOCHONDRIALMEMBRANEPOTENTIALINCD71+NUCLEATEDERYTHROCYTESINPATIENTSWITHCHRONICMOUNTAINSICKNESS

MA Jie

Qinghai University Affiliated Hospital，Xining，China

Objective：The aim of this article was to investigate the changes of apoptosis，cytochrome c (Cyt-C)，and mitochondrial membrane potential(MMP)in CD71+nucleated erythrocytes in patients with chronic mountain sickness(CMS)，and to further explore the possible role of apoptosis in the path of mitochondrion of CD71+nucleated erythrocytes in CMS patients.Methods：The study included 14 CMS patients and 15 normal people.Bone marrow was collected and the bone marrow mononuclear cells(BMMNCs)were separated.The BMMNCs were marked with CD71 monoclonal antibody and stained with Annexin V-FITC/PI.Then the apoptotic index of CD71+nucleated erythrocytes was determined by flow cytometry.CD71+nucleated erythrocytes were sorted out by magnetic column separation technique.Cyt-C mRNA and MMP were detected by RT-qPCR and flow cytometry with JC-1 staining，seperately.Results：The results showed that the apoptotic index ofCD71+nucleated erythrocytes was significantly different between the two groups(P=0.031). The expression of Cyt-C mRNA was significantly different between the two groups(P<0.001).MMP was significantly different between the two groups(P=0.017).The apoptotic index of CD71+nucleated erythrocytes was negatively correlated with hemoglobin in the CMS group(r=-0.569，P=0.034).But there was no significant correlation among apoptosis index，MMP，and Cyt-C mRNA.Conclusions：The decline of apoptosis index of CD71+nucleated erythrocytes may be related to the accumulation of red blood cells in CMS.The increased MMP and decreased Cyt-C mRNA suggest that the change of mitochondrial pathway of apoptosis might be involved in the downregulation of apoptosis in CD71+nucleated erythrocytes of CMS patients.

4034

PATHOLOGICALCHARACTERISTICSOFGASTRICMUCOSALLESIONINPATIENTSWITHEXCESSIVEPOLYCYTHEMIAATHIGHALTITUDE

QIAN Dong-qu，CUO Zhuo-ma，LI Wan-tai ，GE Ri-Li

People′s Hospital of Haixi Mongolian and Tibetan Autono-mous Prefecture Qinghai Province，China

High-altitude polycythemia(HAPC)is characterized by severe symptomatic excessive erythrocytosis(EE；Hb≥19g/dL for women and Hb≥21g/dL for men)and accentuated hypoxemia，which are frequently associated with pulmonary hypertension.However，there are limited data available on the effects of hypoxia- ischemia on HAPC-related gastric mucosal lesion.This study aimed to evaluate the pathological changes of gastroduodenal mucosa in patients with HAPC.183 cases of gastric mucosal lesion in patients with HAPC were studied at a hospital of Haixi Mongolian and Tibetan Autonomous Prefecture(3200m above the sea level)between January 2013 and December 2016.All the patients underwent upper endoscopy and gastric biopsies.Most of them were male Han Chinese(90%)and age between 3 and 49 years.Hemoglobin levels were >21g/dL in all patients.The most frequent diagnosis by endoscopy was gastric ulcer(19.67%)，atrophic gastritis with erosion(43.17%)，nonatrophic gastritis(16.56%)，duodenal ulcer(12.02%)，and duodenal globulitis(8.20%).Histopathological analysis revealed that HAPC induced severe congestion，edema，and multiple hemorrhagic erosions in the gasric mucosa.A dilation and distortion accompanied by hyperemia and bleeding were also observed in ves-sels within gastroduodenal mucosa.Therefore，the present findings suggested that severe present fndings sugested lhat severe chronic hypoxemia and consequent excessive polycythemiain patients with HAPC may induce to impair gastric mucosal barrier and lead to develop chronic gastroduodenal disorder.

4035

STUDYONTHECORRELATIONBETWEENVASCULARLESIONSANDCOGNITIVEFUNCTIONINNATIVETIBETANWITHH-TYPEHYPERTENSIONINPLATEAU

LI Ying-lan，WU Shi-zheng

Qinghai Provincial People′s Hospital，Xining，China

Objective：To explore characteristics of vascular lesions and the correlation between vascular lesions and cognitive function in native Tibetan patients with H-type hypertension in Qinghai-Tibetan Plateau of China.Methods：Sixty-two cases with H-type hypertension and178 cases with non-H-type hypertension were enrolled innative Tibetan patients at high altitude(Yushu city，QinghaiProvince，China；3800m).All the subjects detected carotidartery atheroselerotic plaques and carotid intima-mediathickness(CIMT)with the color Doppler ultrasound，exam-ined the cognitive function with the minimental state exam-ination(MMSE)，and measured the brachial-ankle pulsewave velocity(BaPWV)，and ankle brachial index(ABI)with the Colin-VP1000 type artery stiff diagnosis apparatus.Results：Comparing with non-H-type hypertension，the in-cidence of carotid artery atheroselerotic plaques，CIMT，andBaPWV was significantly higher in the native Tibetan withH-type hypertension(P<0.05)，whereas MMSE and ABIwere significantly decreased(P<0.05).MMSE and ABI were posi-tively correlated with BaPWV，CIMT，and plaques，MMSEwas negatively correlated with ABI and plaques.Conclusions：The patients with H-type hypertension are morelikely to have the peripheral artery structure and function im-pairments and more severe the cognition impaired，whichclosely correlate with high altitude and hypoxia.Hypoxia andspecial national diet(less vegetables and more meat)affect themetabolism of homocysteine.Elevated plasma Hcy level mayaggravate vascular lesions and cognitive impairment in nativeTibetan patients with high blood pressure in the plateau.

4048

PRELIMINARYSTUDYINRIGHTVENTRICULARREMODELINGINPATIENTSWITHCHRONICMOUNTAINSICKNESSWITHCARDIACMAG-NETICRESONANCE

BAO Hai-hua，WANG Wen

Department of Medical Imaging Center，Affiliated Hospitalof QinghaiUniversity，Xining.China

Objective：According to estimates，the number of patientssuffering from chronic mountain sickness(CMS)in QinghaiTibet Plateau is～250，000.The objective of this study was toinvestigate the changes of right ventricle structure and func-tion in CMS patients by using cardiac magnetic resonance(CMR)，Black Blood Sequences，and Movie Sequences.Method：Twenty-fourpatients clinically diagnosed with CMS and 20 he：healthy volunteers whose gender，age，and alti-tude matched were recruited for cardiac MRI scan to obtaintheir right ventricular structure and function-related parame-ters by using heart-specific postprocessing analysis software.Results：(1)Pulmonary artery diameter(PAD)：CMS group：30.7±4.5 mm，normal control group：22.3±4.2 mm.(2)Right ventricular structure：CMS group：End-diastolic rightventricular wall thickness(RVT)6.6 t 1.8 mm，inter-ventricular septum(IVS)10.9±2.6 mm，right ventricularmass(RVM)34.7±15.8 g，right ventricular papillary mus-cle mass(RVPM)30.4±13.6 g，right ventricular end dia-stolic transverse diameter(RVEDTD)40.8±5.6 mm；normal control group corresponding results：3.6±0.8 mm，7.7±1.7 mm，24.7±11.1 g，23.3±8.3 g，36.1 t 5.1 mm.(3)Right heart function measurement result：CMS group：cardiac output(CO)24±1.2 L/(min/m2)，end diastolic vo-lume(EDV)95.2±129.2 mL，end systolic volume(ESV)62.4±21.8 mL；normal control group corresponding results：1.7±7.5 L/(min/m2)，72.0±21.3 mL，46.2±14.1 mL.Com-pared with normal control group，the difference between RVT，PAD，IVS，RVM，RVPM，EDV，ESV，co，and RVEDTD ofCMS group is significant.Conclusions：CMR can accurately assess the structure andfunction of right ventricle in patients with chronic mountain.

4049

CARDIACMAGNETICRESONANCEEVALUATESTHEEFFECTOFMAINPULMONARYARTERYDI-LATATIONONRIGHTHEARTSTRUCTUREANDFUNCTIONWITHCHRONICMOUNTAINSICKNESS

BAO Hai-hua，WANG Wen

Department of Medical Imaging Center，Affiliated Hospitalof QinghaiUniversity，Xining，China

Objective：In some patients with chronic mountain sickness(CMS)，the main pulmonary artery(MPA)is dilated.To acertain extent，MPA-dilation can reflect the pulmonary hy-pertension.This program uses cardiac magnetic resonance(CMR)to explore changes of right ventricular structure andfunction in patients with CMS.Methods：Forty male volunteers who were clinically diagnosedas CMS were collected.CMR scans were performed on allsubjects using the Philips Achieva 1.5T superconducting nu-clear magnetic resonance scanner and the acquired images werepostprocessed and analyzed.The patients(dMPA>30mm)were included in the MPA-dilated group(n=21)，the rest of thepatients(dMPA=30mm)were in the control group(n=19).Results：(1)Right heart structure：The values of right ventriclelateral wall(RVLW)，right ventricle anterior wall(RVAW)，right ventricular end systolic transverse diameter(RVESTD)，and right ventricular end diastolic mass(RVEDM)in theMPA-dilated group were 545±0.97 mm，4.90±0.99 mm，33.23±648 mm，and 4791±14.42 g，rspectively.The val-ues of those in the controlgroup were 3.56±0.71 mm，3.24±0.61 mm，25.71±4.43 mm，and 35.92 t 6.08 g.respetively.(2)Right heart fuction The value of tcupid an-nular sydlic dplacen(TASD)in the MPAdiatcd groupwas 16.95 t 6.88 mm.The value of that in the 25.98±4.21 mm.Compared with thocen e control group，RVLW，RVAW RVESTD，and RVEDM in MPA-dilated group were higher，TASD was significantly lower(P<0.05).Conclusions：Some CMS patients′ MPA was dilated，and the structure of right heart changes obviously and the function changes slightly.

4093

UPDATEOFSLEEPDISORDERANDCHRONICMOUNTAINSICKNESS

GUAN Wei

Qinghai University Afliated Hospital，Xining，Qinghai，China

The pathogenesis of chronic mountain sickness(CMS)is nottotaly clear.People believe that sleep disorder and obesityare the risk factors of cMS.However，the type of sleep dis-order of CMS patients versus the type of sleep disorder ofobese CMS patients is not clear. We collected 82 patientswho lived at high altitude(>3000m)and suspected as CMS(the hemoglobin all >21g/L，CMS score >5).We dividedthem into two groups according to the body mass index(BMI <24kg/m2and BMI >25kg/m2)and did the poly-somnography(PSG)for them.The hemoglobin concentrationwas significantly higher in obese group than in nonobesegroup(243.7±8.1vs.220.3±4.9g/L，P<0.01).The ap-nea/hypopnea index(AHI)was significantly higher in obesegroup than in nonobese group(46.7[33.5，57.2] vs.14.7[114，21.8]，P<0.01).The main type of apnea was ob-structive apnea in obese group.Central apnea，mixture apnea，periodic breathing，and hypopnea were also observed in ob-ese group.The hypopnea was the main type of sleep disorderin the nonobese group.The mean and lowest sleep oxygensaturation(SaO2)were significantly lower in the obese groupthan in the nonobese group(allP<0.01).We concluded thatobese patients with polycythemia at high altitude shouldperform the PSG and if the type of sleep disorder showed asobstructive sleep apnea，these patients should be diagnosed asobstructive sleep apnea/hypopnea syndrome.So we can givethese people the continuous positive airway pressure.Thesepatients suffered from hypoxia due to OSAHS and high al-titude，so the situations of these patients were even moresevere than pure OSAHS patients and CMS patients.