Preserved peak exercise capacity in Andean highlanders with excessive erythrocytosis both before and after isovolumic hemodilution.
Preserved peak exercise capacity in Andean highlanders with excessive erythrocytosis both before and after isovolumic hemodilution.
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DOI：
10.1152/japplphysiol.00439.2022
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发表时间：
2023-01-01
影响因子：
3.3
通讯作者：
Villafuerte, Francisco C.
中科院分区：
文献类型：
--
作者：
Anza-Ramirez, Cecilia;Gu, Wanjun;Macarlupu, Jose L.;Figueroa-Mujica, Romulo J.;Vizcardo-Galindo, Gustavo A.;Heinrich, Erica C.;Tift, Michael S.;Wagner, Harrieth E.;Wagner, Peter D.;Simonson, Tatum S.;Villafuerte, Francisco C.
关键词：
在慢性高原病(CMS)中，由于红细胞增多(Ee，[HB]≥21g/dL)而增加的血氧携带能力可以被心输出量(Q̇t)受损和肺和肌肉中O2扩散受限所抵消，尤其是在运动中。我们假设EE导致峰值V̇O2降低，尽管血液携氧能力增加，且等容血液稀释(IVHD)可提高运动能力。在秘鲁塞罗德帕斯科(4,340米)的14名男性居民中，6名患有EE，8名没有EE，我们测量了峰值周期运动能力、V-̇O2、Q-̇-t、动脉血气参数和(静息)血容量。IVHD后患有EE的参与者重复了这一过程，红细胞压积降低了20%(从67%降至53%)。根据这些数据，我们量化了氧气运输途径的主要组成部分(通气性、肺泡-毛细血管扩散、Q-̇t和血液-肌肉线粒体扩散)。与非EE对照组相比，EE患者的V̇O2峰值、全身O2输送和O2摄取相似，但Q̇t较低，动脉[O2]较高。IVHD后，峰值V̇O2被保留(但没有增强)，较低的O2输送(尽管Q̇t较高)被较大的O2摄取量所平衡。14个个体之间运动能力的显著差异基本上完全是由肺和肌肉O2扩散电导的差异解释的，而不是由换气[Hb]或Q̇t的任何差异解释的。总之，EE不会导致安第斯男性V̇O2峰值较低，IVHD保持但不会增强运动能力。新发现和值得注意的患有和不患有过度红细胞增多症(EE)的男性安第斯高原人在4,340m处的V̇O2峰值相似，EE的动脉[O2]较高，心输出量(Q̇t)较低，因此维持相似的O2输送。等容血液稀释对EE患者的V̇O2峰值无影响(红细胞压积从67%降至53%)，较低的O2输送被略微增加的Q̇t和较大的O2提取所抵消。肺和肌肉弥散能力的差异，而不是红细胞压积的变化，基本上可以解释V̇O2峰值的所有个体间差异。
In chronic mountain sickness (CMS), increased blood oxygen (O2)-carrying capacity due to excessive erythrocytosis (EE, [Hb] ≥ 21 g/dL) could be offset, especially during exercise by both impaired cardiac output (Q̇t) and O2 diffusion limitation in lungs and muscle. We hypothesized that EE results in reduced peak V̇o2 despite increased blood O2-carrying capacity, and that isovolumic hemodilution (IVHD) improves exercise capacity. In 14 male residents of Cerro de Pasco, Peru (4,340 m), six with and eight without EE, we measured peak cycle-exercise capacity, V̇o2, Q̇t, arterial blood gas parameters, and (resting) blood volume. This was repeated for participants with EE after IVHD, reducing hematocrit by 20% (from 67% to 53%). From these data, we quantified the major O2 transport pathway components (ventilation, pulmonary alveolar-capillary diffusion, Q̇t, and blood-muscle mitochondria diffusion). Participants with EE had similar peak V̇o2, systemic O2 delivery, and O2 extraction as non-EE controls, however, with lower Q̇t and higher arterial [O2]. After IVHD, peak V̇o2 was preserved (but not enhanced), with lower O2 delivery (despite higher Q̇t) balanced by greater O2 extraction. The considerable variance in exercise capacity across the 14 individuals was explained essentially completely by differences in both pulmonary and muscle O2 diffusional conductances and not by any differences in ventilation, [Hb], nor Q̇t. In conclusion, EE does not result in lower peak V̇o2 in Andean males, and IVHD maintains, but does not enhance, exercise capacity. NEW & NOTEWORTHY Male Andean highlanders with and without excessive erythrocytosis (EE) have similar peak V̇o2 at 4,340 m, with higher arterial [O2] in EE and lower cardiac output (Q̇t), thus maintaining similar O2 delivery. Peak V̇o2 in participants with EE was unaffected by isovolumic hemodilution (hematocrit reduced from 67% to 53%), with lower O2 delivery balanced by slightly increased Q̇t and greater O2 extraction. Differences in lung and muscle diffusing capacity, and not hematocrit variation, accounted for essentially all interindividual variance in peak V̇o2.
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