Chronic mountain sickness in Chinese Han males who migrated to the Qinghai-Tibetan plateau: application and evaluation of diagnostic criteria for chronic mountain sickness.
Chronic mountain sickness in Chinese Han males who migrated to the Qinghai-Tibetan plateau: application and evaluation of diagnostic criteria for chronic mountain sickness.
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DOI：
10.1186/1471-2458-14-701
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发表时间：
2014-07-09
影响因子：
4.5
通讯作者：
Gao W
中科院分区：
文献类型：
--
作者：
Jiang C;Chen J;Liu F;Luo Y;Xu G;Shen HY;Gao Y;Gao W
慢性高山病（CMS）最初以血红蛋白（Hb）过多为特征，目前使用基于评分的诊断标准结合过度红细胞增多和临床症状来诊断。然而，目前的标准适用性有限。我们应用这些标准对1，029名移居青藏高原并在那里居住了2-96个月的中国汉族男性进行了CMS患病率及其与Hb浓度、海拔高度和居住时间的相关性研究。使用最新批准的诊断标准结合过度红细胞增多和临床症状筛选受试者的CMS。测量Hb浓度，用k-均值聚类确定临界点。采用二分类Logistic回归分析和曲线拟合分析评价易感因素。(1)青藏高原CMS患病率为17.8%（183/1029人，CMS评分≥ 6分，Hb ≥ 210 g/L），高于以往报道的患病率。(2)以200 g/L为分界点，将个体分为两个Hb聚类，在低Hb聚类（Hb < 200 g/L）中，随着Hb的增加，氧饱和度保持稳定;在高Hb聚类（Hb ≥ 200 g/L）中，随着Hb的增加，氧饱和度降低。(3)与CMS发展相关的两个关键因素是居住在海拔4,500米的地方和居住60个月。我们提出的评分系统比以前的诊断标准更敏感，有利于CMS患者的早期筛查和治疗。我们的研究结果表明，调整后的Hb阈值为200 g/L（而不是210 g/L）更适合于所有海拔高度的汉族个体。由于CMS患者红细胞过多的病理生理作用，使用CMS评分系统，Hb水平的权重应评分≥ 6分。此外，我们的数据表明，在高海拔地区，特别是>4500 m的前60个月内，通过定期体检进行CMS早期筛查的重要性。
Chronic mountain sickness (CMS), originally characterized by excess hemoglobin (Hb), is currently diagnosed using score-based diagnostic criteria combined with excessive erythrocytosis and clinical symptoms. However, the current criteria have limited applicability. We applied these criteria to 1,029 Chinese Han males migrated to and have been stayed at the Qinghai-Tibet plateau (3,700–5,000 m) for 2–96 months to investigate the prevalence of CMS and its correlations with Hb concentration, altitude, and the length of residence. Subjects were screened for CMS using the latest approved diagnostic criteria combined with excessive erythrocytosis and clinical symptoms. Hb concentrations were measured, and a cut-off point was determined with k-means clustering. Predisposing factors were evaluated with binary logistic analysis and curve fitting analysis. (1) The prevalence of CMS at the Qinghai-Tibetan plateau was 17.8% (183/1029 subjects, with CMS score ≥ 6, and Hb ≥ 210 g/L), which is higher than that previously reported. (2) While individuals were identified into two Hb clusters with a cut-off point of 200 g/L, in the low-Hb cluster (Hb < 200 g/L), the oxygen saturation remained stable as the Hb increased; in the high-Hb cluster (Hb ≥ 200 g/L), the oxygen saturation decreased as the Hb increased. (3) Two critical factors associated with CMS development were residence at an altitude of 4,500 m and a 60-month length of residence. Our presenting scoring system is more sensitive than previous diagnostic criteria and favors early screening and treatment of patients with CMS. Our finding suggests that an adjusted Hb threshold of 200 g/L (instead of 210 g/L) is more adaptable in Han individuals at all altitudes. The weight of Hb level should score ≥ 6 points using the CMS scoring system because of the pathophysiologic role of excessive erythrocytosis in patients with CMS. In addition, our data suggest the importance of early screening of CMS via regular medical examinations within the first 60 months of residence at high altitudes, especially >4500 m.
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影响因子：
2.1
作者：
León-Velarde, F;Maggiorini, M;Zubieta-Calleja, G
通讯作者：
Zubieta-Calleja, G
影响因子：
9.6
作者：
Pratali, Lorenza;Rimoldi, Stefano F.;Sartori, Claudio
通讯作者：
Sartori, Claudio
影响因子：
2.6
作者：
Beall, CM
通讯作者：
Beall, CM
影响因子：
9.6
作者：
Groepenhoff, Herman;Overbeek, Marieke J.;Naeije, Robert
通讯作者：
Naeije, Robert
影响因子：
9.6
作者：
Rimoldi, Stefano F.;Rexhaj, Emrush;Sartori, Claudio
通讯作者：
Sartori, Claudio