高原病命名与临床分型意见

高原病命名与临床分型意见１９９２年１０月２１日～１９９２年１０月２５日由中华医学会高原医学学会在海南省海口市召开的全国高原病命名与分型学术讨论会上，与会专家和代表对高原病命名与分型提出了意见。为有利于国际学术交流，在参考了国际高原病命名与分型后，将讨...     

关于对高原病命名及临床分型的综述

自1918年Schneider 把长期持续缺氧所致的反应称为高山病(Mountain Sickness)以来,虽然在世界不同高原地区对各型高原病的观察和研究经历了相当长的时间,但由于高原病的表现形式复杂,许多问题尚未完全解决,迄今对高原病的命名及临床分型仍未臻一致,由于高原病的命名不统一,临床分型不一致,甚至相互混淆,这极大地妨碍了高原医学的科研及学术交流,也不便于正确指导防治。因此,对高原病的命名及临床分型统一标化是十分必要的。早在1979 年国际高原医学会议上即有人建议将对高原病及高原医学的名词、术语进行国际统一标化,但至今尚未取得完全一致。现就国内外关于高原病的命名及临床分型概况作一综述。     

我国高原病命名、分型及诊断标准

我国高原病命名、分型及诊断标准（中华医学会第三次全国高原医学学术讨论会推荐稿１９９５，９）高原病（Ｈｉｇｈａｌｔｉｔｕｄｅｄｉｓｅａｓｅ，ＨＡＤ）是发生于高原低氧环境的一种特发性疾病。高原低压性缺氧是致病的主要因素，低氧性病理生理改变是发病的基础和临...     

关于对高原病命名及临床分型的综述

自1918年Schneider把长期持续缺氧所致的反应称为高山病(Mountain Sickness)以来,虽然在世界不同高原地区对各型高原病的观察和研究经历了相当长的时间,但由于高原病的表现形式复杂,许多问题尚未完全解决,迄今对高原病的命名及临床分型仍未臻一致,由于高原病的命名不统一,临床分型不一致,甚至相互混淆,这极大地妨碍了高原医学的科研及学术交流,也不便于正确指导防治。因此,对高原病的命名及临床分型统一标化是十分必要的。早在1979年国际高原医学会议上即有人建议将对高原病及高原医学的名诃、术语进行国际统一标化,但至今尚未取得完全一致。现就国内外关于高原病的命名及临床分型概况作一综述。     

高原病临床分型探讨

本文依据高原病发病原因、临床表现、发病的急缓和病程的长短及预后提出高原病的临床分型。认为本分型意见有利于临床诊断、疗效和预后判断,以及疾病统计管理等。并对疾病的分期作了阐述。     

建立我国高原病命名及分型的综合评论

建立我国高原病命名及分型的综合评论青海省高原医学科学研究所吴天一虽然经历了长期在世界不同高山和高原地区对各型高原（山）病的观察和研究，但迄今对高原病的命名和分型国际上仍较不统一。甚至出现将相同的病名冠于性质不同的病型，导致混乱。对此，著名高原医学家Ｃ...     

慢性高原病

慢性高原病国外统称为“蒙赫氏病”,未做具体分型。为便于临床诊断治疗我国进行了分型,现分述如下。 高原红细胞增多症 高原红细胞增多症是慢性高原病常见的一种类     

关于我国高原病命名、分型及诊断标准（1995年中华医学会标准）及其英译本的介绍

主编吴天一按语：最近，收到美国高原医学及生物学杂志（High Altitude Medicine and Biology）主编John B．West教授的邀请，他指出我国1995年中华医学会关于中国高原病命名、分型及诊断标准，很有特色，一定会引起国际高原医学者的浓厚兴趣和互相交流，希望能翻译成英文加以介绍，我和加州大学袁小健教授完成了这一译本（并将在2010年2期High Alt．Med．Biol．上发表）。     

关于我国高原病命名、分型及诊(1995年中华医学会标准)及其英译本的介绍

主编吴天一按语:最近,收到美国高原医学及生物学杂志(High Altitude Medicine and Biology)主编John B.west教授的邀请,他指出我国1995年中华医学会关于中国高原病命名、分型及诊断标准,很有特色,一定会引起国际高原医学者的浓厚兴趣和互相交流,希望能翻译成英文加以介绍,我和加州大学袁小健教授完成了这一译本(并将在2010年2期High Alt.Med.Biol.上发表).     

胰腺炎并发假性囊肿或积液的CT分型与命名

目的：探讨胰腺炎并发假性囊肿或积液的CT分型与命名，为其诊断及鉴别诊断提供依据。方法：分析我院收治的胰腺炎合并假性囊肿或积液40例的CT影像学特征、发病机制及病理特点，并根据以上特征进行临床分型与命名。结果：以胰腺为主体，由近至远对胰腺炎并发假性囊肿或积液进行分型和命名，可分为胰内型、胰周型、胰内伴胰周型、异位型、胰内伴异位型、胰周伴异位型和胰内胰周伴异位型等7种类型。结论：分型与命名既能反映病源性质，又能确切地反映病变受累范围及CT扫描的特征，有利于诊断及制定有效治疗措施和选择手术时机及方式。     

Acute medical problems in the Himalayas outside the setting of altitude sickness

Well-recognized medical threats at high altitude (>2,500 m) include acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), and high altitude cerebral edema (HACE). Thousands of travelers in the Himalayas are exposed annually to these often life-threatening syndromes. Their recognition and treatment has advanced considerably in recent years. In the Himalayas, we frequently see acute medical problems outside the setting of AMS and the two types of altitude edemas. Many of these other conditions are also hypoxia related and sometimes may mimic the classic high altitude illnesses of AMS, HAPE, and HACE. Although the vast majority of these medical problems are neurological, pulmonary and other organ system dysfunction also occur. These "non-high altitude sickness" disease entities in persons who sojourn to remote mountainous environments are reviewed in this paper to enhance their recognition, diagnosis, and treatment.     

Acute mountain sickness in Jade Mountain climbers of Taiwan

BACKGROUND: Although there are more than 200 peaks higher than 3000 m in the Taiwan Alps, no data on the incidence of acute mountain sickness (AMS) are available. This study investigated the incidence of AMS in Jade Mountain climbers. METHODS: The study was performed at the entrance of Jade Mountain, the highest peak (3952 m) in Taiwan. A standardized form was used to collect information. All the recorders had previously been trained in the management of high altitude illness. The Lake Louise consensus was used for the diagnosis of AMS. RESULTS: There were 93 trekkers (18 females and 71 males) who were surveyed. Four records with incomplete data were excluded, leaving 89 records for analysis. The ages ranged from 20-68 yr, with an average age of 41.1 +/- 11.2 SD. All subjects had a home residence below 1 km. The most common high altitude symptoms were headaches. Some 25 trekkers (28%) [corrected] met the diagnoses of AMS. The most common site of the AMS cases feeling their worst symptoms was in the midway overnight hut, and not on the summit. The lower the O2 saturation recorded at the entrance (2659 m) of Jade Mountain, the higher the score of the Lake Louise Acute Mountain Sickness Score (LLAMSS). CONCLUSIONS: Acute mountain sickness is a common problem in Taiwan summit climbers. In our study, 28% [corrected] of the Jade Mountain trekkers met the diagnosis of AMS; however, the incidence of AMS was lower than that of other studies at similar altitudes.     

沙美特罗替卡松吸入剂预防急性高原反应的效果观察

目的：观察沙美特罗替卡松粉吸入荆预防急性高原反应的效果。方法：55名青年随机分为沙美特罗组（n=31）和安慰剂组（n=24），自海拔1400m历时4天进入5200m，第2天开始，沙美特罗组每天早晚各吸入沙美特罗替卡松粉一个剂量（沙美特罗50μg，丙酸氟替卡松100μg），连续7天；安慰荆组用同样方法吸入少量生理盐水。以军用卫生标准GJB1098-91《急性高原反应的诊断和处理原则》随访观察第2天、4天、7天急性高原反应的严重程度、SaO2和脉率。结果：进入海拔5200m第7天安慰剂组急性高原反应症状较沙美特罗组严重（P〈0．05），第2天、4天安慰剂组脉率较沙美特罗组减慢（P〈0．05），SaO2两组无显著性意义（P〉0．05）。随访期间沙美特罗组发生一例高原脑水肿，安慰剂组发生一例高原肺水肿。结论：沙美特罗替卡松粉吸入剂预防急性高原反应无确切效果。     

对快速进入高原部队预防急性高原病的措施探讨

目的了解急性高原病(AMS)的发病情况并探讨其预防措施。方法2006—2007年两次进入高原某地进行军事演练,伴随卫勤保障任务,通过在平原集结时之前,进行身体调整,加大训练强度,进入高原后,延长休整天数,进行心理干预,开展AMS知识的宣传教育,采用问卷、卫生队、卫生室进行病员登统计、个别问诊、检查的方法,了解部队进入高原后AMS的发病情况。结果2006年9—10月份与2007年9—10月份两次进入高原人员年龄分布无统计学差异(P>0.05),而发病率由21.6%下降为13.4%及住院率0.72%下降为0.48%,2007年9—10月份与2006年9—10月份重度急性高原反应、高原肺水肿和高原脑水肿发病率都有所减低。结论在常规的卫勤保障基础上,应调整进入高原的休整期,一般7d左右为宜,加强高原卫生宣传教育,正确引导官兵们对低氧危害性和机体代偿能力的认识,克服高原恐惧心理和麻痹大意思想;提高医务人员的业务水平,增强责任心。这样可以大大地降低AMS的发病率和住院率,有效地保障官兵的身体健康。     

Acute mountain sickness in a subject with metabolic syndrome at high altitude

Abstract Strapazzon, Giacomo, Annalisa Cogo, and Andrea Semplicini. Acute mountain sickness in a subject with metabolic syndrome at high altitude. High Alt. Med. Biol. 9:245-248, 2008.-Visitors at high altitude are increasing in age and comorbidities, which can lead to a failure in acclimatization. We describe the development of acute mountain sickness (AMS) in a 44-year-old man with metabolic syndrome and the time- and altitude-dependent correlation between the development of AMS and blood pressure and heart rate changes. Our observations support a dominant role of endothelial dysfunction in the pathogenesis of AMS and suggest new behavioral indications.     

Hypoxic ventilatory response,ventilation, gas exchange,and fluid balance in acute mountain sickness

To examine whether sea-level hypoxic ventilatory responses (HVR) predict acute mountain sickness (AMS) and document temporal changes in ventilation, HVR, gas exchange, and fluid balance, we measured these parameters at low altitude (100 m) and daily during 3 days at high altitude (4559 m). At low altitude, there were no significant differences in rest or exercise isocapnic HVR, poikilocapnic HVR at rest, and hypercapnic ventilatory response between 12 subjects without significant AMS and 11 subjects who fell sick. No low altitude ventilatory responses correlated with AMS or fluid balance at high altitude. On day 1, isocapnic HVR was significantly lower in the AMS group [0.86 +/- 0.43 (SD) vs. 1.43 +/- 0.63 L/min/% Sa(O2), p < 0.05). AMS was associated with higher AaD(O2), lower Pa(O2), and Sa(O2), while Pa(CO2) was not different between subjects with and without AMS. Both groups showed equivalent reductions in urine volume, sodium output, and gain in body weight on day 1 while climbing to 4559 m, but on day 2 only subjects without AMS had diuresis, natriuresis, and weight loss. We conclude that (1) susceptibility to AMS, fluid balance, and ventilation at high altitude cannot be predicted by low altitude HVR testing and (2) that the failure to increase HVR on arrival at high altitude and impaired gas exchange, possibly due to interstitial edema, may account for the more severe hypoxemia in AMS.     

EPAS1 and VEGFA gene variants are related to the symptoms of acute mountain sickness in Chinese Han population:a cross-sectional study

Background:More people ascend to high altitude(HA)for various activities,and some individuals are susceptible to HA illness after rapidly ascending from plains.Acute mountain sickness(AMS)is a general complaint that affects activities of daily living at HA.Although genomic association analyses suggest that single nucleotide polymorphisms(SNPs)are involved in the genesis of AMS,no major gene variants associated with AMS-related symptoms have been identified.Methods:In this cross-sectional study,604 young,healthy Chinese Han men were recruited in June and July of 2012 in Chengdu,and rapidly taken to above 3700 m by plane.Basic demographic parameters were collected at sea level,and heart rate,pulse oxygen saturation(SpO2),systolic and diastolic blood pressure and AMS-related symptoms were determined within 18-24 h after arriving in Lhasa.AMS patients were identified according to the latest Lake Louise scoring system(LLSS).Potential associations between variant genotypes and AMS/AMS-related symptoms were identified by logistic regression after adjusting for potential confounders(age,body mass index and smoking status).Results:In total,320 subjects(53.0％)were diagnosed with AMS,with no cases of high-altitude pulmonary edema or high-altitude cerebral edema.SpO2 was significantly lower in the AMS group than that in the non-AMS group(P=0.003).Four SNPs in hypoxia-inducible factor-related genes were found to be associated with AMS before multiple hypothesis testing correction.The rs6756667(EPAS1)was associated with mild gastrointestinal symptoms(P=0.013),while rs3025039(VEGFA)was related to mild headache(P=0.0007).The combination of rs6756667 GG and rs3025039 CT/TT further increased the risk of developing AMS(OR=2.70,P＜0.001).Conclusions:Under the latest LLSS,we find that EPAS1 and VEGFA gene variants are related to AMS susceptibility through different AMS-related symptoms in the Chinese Han population;this tool might be useful for screening susceptible populations and predicting clinical symptoms leading to AMS before an individual reaches HA.     

No correlation between plasma levels of vascular endothelial growth factor or its soluble receptor and acute mountain sickness

Increased plasma levels of vascular endothelial growth factor (VEGF) due to lower levels of its soluble receptor (sFlt-1) had been suggested to cause vasogenic brain edema and thereby to cause the symptoms of acute mountain sickness (AMS). We tested this hypothesis after active ascent to high altitude. Plasma was collected from 31 subjects at low altitude (100 m) before (LA1) and after (LA2) 4 weeks of aerobic exercise training in normobaric hypoxia or normoxia, and one night after ascent to high altitude (4559 m). Training modalities (hypoxia or normoxia) did not influence VEGF- and sFlt-1-levels. Therefore, data of both training groups were analyzed together. After one night at 4559 m, 18 subjects had AMS (AMS+), 13 had no AMS (AMS-). In AMS+ and AMS-, VEGF was 110 ± 75 (SD) pg/ml vs. 104 ± 82 (p = 0.74) at LA1, 63 ± 40 vs. 73 ± 50 (p = 0.54) at LA2, and 88 ± 62 vs. 104 ± 81 (p = 0.54) at 4559 m, respectively. Corresponding values for sFlt-1 in AMS+ and AMS- were 81 pg/ml ± 13.1 vs. 82 ± 17 (p = 0.97), 79 ± 11 vs. 80 ± 16 (p = 0.92) and 139 ± 28 vs. 135 ± 31 (p = 0.70), respectively. Absolute values or changes of VEGF were not correlated and those of sFlt-1 slightly correlated with AMS scores. These data provide no evidence for a role of plasma VEGF and sFlt-1 in the pathophysiology of AMS. They do, however, not exclude paracrine effects of VEGF in the brain.