Exercise Induces Rapid Interstitial Lung Water Accumulation in Patients With Chronic Mountain Sickness
Exercise Induces Rapid Interstitial Lung Water Accumulation in Patients With Chronic Mountain Sickness
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DOI：
10.1378/chest.11-0084
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发表时间：
2012-04-01
期刊：
影响因子：
9.6
通讯作者：
Sartori, Claudio
中科院分区：
文献类型：
--
作者：
Pratali, Lorenza;Rimoldi, Stefano F.;Sartori, Claudio
背景：慢性高原病（CMS）是世界山区的一个主要公共卫生问题。在其更高级的阶段，经常发现运动不耐症，但其潜在机制尚不清楚。最近的证据表明，运动诱导的肺动脉高压是显着夸大CMS。我们推测这个问题可能会导致肺积液，加重运动时低氧血症。（胸部超声检查）、肺动脉压和左心室功能，在3，600 m的静息和运动期间对15名CMS患者和20名对照受试者进行了研究。高原运动除1例（14/15）CMS患者外，其他所有患者均迅速引起肺间质液蓄积，并进一步加重原有低氧血症。相比之下，在健康的高海拔居民中，运动不会引起大多数受试者（20人中的16人）的液体积聚（P = .002 vs CMS），也不会改变动脉氧合。在CMS患者中，运动诱导的肺间质液积聚和低氧血症伴随着肺动脉压比对照组高两倍以上的增加（P <0.001），但没有左心室功能障碍的证据。吸氧可明显减轻运动性肺动脉高压（P < .01）和间质液积聚（P <0.05），但在对照组中没有检测到影响。据我们所知，这些发现提供了第一个直接证据，即运动可诱导CMS患者的快速间质性肺液积聚和低氧血症，这些似乎与过度的肺功能有关。高血压我们认为，这个问题有助于CMS患者的运动不耐受。试验登记处：ClinicalTrials.gov;编号：NCT 01182792; URL：www.clinicaltrials.gov CHEST 2012; 141（4）：953-958
Background: Chronic mountain sickness (CMS) is a major public health problem in mountainous regions of the world. In its more advanced stages, exercise intolerance is often found, but the underlying mechanism is not known. Recent evidence indicates that exercise-induced pulmonary hypertension is markedly exaggerated in CMS. We speculated that this problem may cause pulmonary fluid accumulation and aggravate hypoxemia during exercise.Methods: We assessed extravascular lung water (chest ultrasonography), pulmonary artery pressure, and left ventricular function in 15 patients with CMS and 20 control subjects at rest and during exercise at 3,600 m.Results: Exercise at high altitude rapidly induced pulmonary interstitial fluid accumulation in all patients but one (14 of 15) with CMS and further aggravated the preexisting hypoxemia. In contrast, in healthy high-altitude dwellers exercise did not induce fluid accumulation in the majority of subjects (16 of 20) (P = .002 vs CMS) and did not alter arterial oxygenation. Exercise-induced pulmonary interstitial fluid accumulation and hypoxemia in patients with CMS was accompanied by a more than two times larger increase of pulmonary artery pressure than in control subjects (P < .001), but no evidence of left ventricular dysfunction. Oxygen inhalation markedly attenuated the exercise-induced pulmonary hypertension (P < .01) and interstitial fluid accumulation (P < .05) in patients with CMS but had no detectable effects in control subjects.Conclusions: To our knowledge, these findings provide the first direct evidence that exercise induces rapid interstitial lung fluid accumulation and hypoxemia in patients with CMS that appear to be related to exaggerated pulmonary hypertension. We suggest that this problem contributes to exercise intolerance in patients with CMS. Trial registry: ClinicalTrials.gov; No.: NCT01182792; URL: www.clinicaltrials.gov CHEST 2012; 141(4):953-958