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Article(id=1200024243447624637, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1200024241572770746, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.1485.2023.0320, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1657123200000, receivedDateStr=2022-07-07, revisedDate=null, revisedDateStr=null, acceptedDate=1659801600000, acceptedDateStr=2022-08-07, onlineDate=1764037675009, onlineDateStr=2025-11-25, pubDate=1695830400000, pubDateStr=2023-09-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1764037675009, onlineIssueDateStr=2025-11-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1764037675009, creator=13701087609, updateTime=1764037675009, updator=13701087609, issue=Issue{id=1200024241572770746, tenantId=1146029695717560320, journalId=1189873630562394117, year='2023', volume='48', issue='9', pageStart='993', pageEnd='1112', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1764037674563, creator=13701087609, updateTime=1764038723302, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1200028640353288193, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1200024241572770746, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1200028640353288194, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1200024241572770746, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1081, endPage=1088, ext={EN=ArticleExt(id=1200024243703477186, articleId=1200024243447624637, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Analysis of the prevalence and risk factors of hypertension in young men firstly entering the 4500 m plateau for half a year, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To investigate the prevalence and risk factors of hypertension in young men first exposed to high altitude for half a year at 4500 m. Methods A total of 228 young men who firstly traveled from a plain area to an altitude of 4500 meters in northern Tibet and stayed there for six months were recruited in present study. They were divided into hypertension group (HTN, n=66) and non-hypertension group (NTN, n=162) based on their blood pressure status. A self-administered questionnaire, the Pittsburgh Sleep Quality Index (PSQI), physical examinations and laboratory tests were used to investigate the risk factors and clinical complications of hypertension. The general data and clinical complications of the two groups were compared, and multivariate logistic regression was used to analyze the risk factors of high-altitude hypertension and predisposition of clinical complications. Results Among the 228 individuals, 66 developed hypertension (incidence of 28.9%), including 52 cases of stage Ⅰ hypertension and 14 cases of stage Ⅱ hypertension. Fifty-eight individuals had isolated diastolic hypertension, and 8 individuals had combined systolic and diastolic hypertension. The proportions of obesity and overweight, central obesity, smoking over 10 cigarettes per day, family history of hypertension, dyslipidemia, and hyperuricemia were significantly higher in HTN group than those in NTN group (P<0.05). The PSQI score was also higher significantly in HTN group than that in NTN group (P<0.001). Multivariate logistic regression analysis showed that hyperuricemia (P=0.02), central obesity (P=0.04), family history of hypertension (P=0.03) and sleeping quality (P<0.001) were the independent risk factors for high-altitude hypertension. The proportion of clinical complications in the past month in HTN group was significantly higher than that in NTN group (P=0.001), and the proportion of three or more kinds of clinical complications was also higher in HTN group than that in NTN group (P=0.01). After adjusting for demographic differences, the risk of dizziness and headache in HTN group was higher than that in NTN group (P<0.05). Conclusions Young men firstly exposed to an altitude of 4500 meters still have a high incidence of hypertension after six months, mostly stage Ⅰ hypertension with diastolic pressure elevation; Hyperuricemia, central obesity, family history of hypertension, and poor sleep quality are the independent risk factors for high-altitude hypertension. High-altitude hypertension can cause various clinical complications, and the higher risk of accompanying dizziness and headache.

, correspAuthors=Ming Yuan, authorNote=null, correspAuthorsNote=
E-mail:
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目的 研究首次暴露于海拔4500 m地区并停留半年时间的青年男性高血压发病情况及其危险因素。方法 纳入由平原首次前往藏北海拔4500 m地区并停留半年时间的青年男性228例，根据血压情况分为高血压(HTN)组(n=66)与非高血压(NTN)组(n=162)。采用自制调查问卷、匹兹堡睡眠质量指数量表(PSQI)进行调查，并进行体格检查、实验室检测以了解高血压相关危险因素及伴随症状。采用多因素logistic回归分析高原高血压的危险因素及伴随症状的发生倾向。结果 228例中青年男性66例发生高血压，发病率为28.9%，其中Ⅰ级高血压52例，Ⅱ级高血压14例；单纯舒张期高血压58例，收缩压合并舒张压升高8例。HTN组肥胖及超重、中心性肥胖、吸烟>10支/d、高血压家族史、血脂异常、高尿酸血症的比例明显高于NTN组(P<0.05)，PSQI评分明显高于NTN组(P<0.001)。多因素logistic回归分析显示，高尿酸血症(P=0.02)、中心性肥胖(P=0.04)、高血压家族史(P=0.03)、PSQI评分(P<0.001)是高原高血压的独立危险因素。HTN组近1个月伴随不适症状的比例明显高于NTN组(P=0.001)，伴随3种及以上不适的占比也高于NTN组(P=0.01)，调整人口学差异后，HTN组伴随头晕及头痛的风险均高于NTN组(P<0.05)。结论 青年男性首次暴露于4500 m地区半年时间仍伴有较高的高血压发病率，主要为Ⅰ级高血压且以舒张压升高为主；高尿酸血症、中心性肥胖、高血压家族史、睡眠质量差是高原高血压的独立危险因素；高原高血压易引起多种不适，且伴随头晕、头痛的风险较高。

, correspAuthors=袁铭, authorNote=null, correspAuthorsNote=
袁铭，E-mail：
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邓龙祥，医学硕士，主治医师，主要从事高血压疾病的诊治及冠状动脉介入治疗工作

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邓龙祥，医学硕士，主治医师，主要从事高血压疾病的诊治及冠状动脉介入治疗工作

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邓龙祥，医学硕士，主治医师，主要从事高血压疾病的诊治及冠状动脉介入治疗工作

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The 2018 lake louise acute mountain sickness score[J]. High Alt Med Biol, 2018, 19(1): 4-6., articleTitle=The 2018 lake louise acute mountain sickness score, refAbstract=null)], funds=[Fund(id=1200066184273036156, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200024243447624637, awardId=2021SF-324, language=EN, fundingSource=Key Research and Development Projects for Social Development Planning in Shaanxi Province(2021SF-324), fundOrder=null, country=null), Fund(id=1200066184356922238, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200024243447624637, awardId=2021SF-324, language=CN, fundingSource=陕西省社会发展计划重点研发项目(2021SF-324), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1200066179856433931, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200024243447624637, xref=1, ext=[AuthorCompanyExt(id=1200066179864822540, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200024243447624637, companyId=1200066179856433931, language=EN, 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articleId=1200024243447624637, language=CN, label=图3, caption=影响高原高血压发生的多因素logistic回归森林图, figureFileSmall=UB6Fo+o0q4aQ7NdjBKI3og==, figureFileBig=SIg82hwARL4JjBpAibIlXw==, tableContent=null), ArticleFig(id=1200066183560004457, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200024243447624637, language=EN, label=Tab.1, caption=

Comparison of the baseline data between HTN group and NTN group

, figureFileSmall=null, figureFileBig=null, tableContent=
指标 总体(n=228) HTN(n=66) NTN(n=162) Z/χ2/t P
年龄[岁, M(Q1, Q3)] 23.0(21.0, 27.0) 24.5(21.0, 28.0) 23.0(21.0, 26.3) -0.718 0.470
文化程度[例(%)] 0.004 0.950
大专以下 96(42.1) 28(42.4) 68(42.0)
大专及以上 132(57.9) 38(57.6) 94(58.0)
BMI[例(%)] 5.871 0.015
<24 kg/m2 179(78.5) 45(68.2) 134(82.7)
≥24 kg/m2 49(21.5) 21(31.8) 28(17.3)
SBP[mmHg, M(Q1, Q3)] 118.0(109.0, 124.0) 123.0(119.0, 132.0) 115.0(107.0, 121.0) -7.083 <0.001
DBP[mmHg, M(Q1, Q3)] 83.0(78.0, 91.0) 94.0(92.0, 98.3) 80.0(76.0, 83.0) -11.847 <0.001
中心性肥胖[例(%)] 31(13.6) 15(22.7) 16(9.9) 6.592 0.010
吸烟[例(%)] 4.947 0.084
0支/d 93(40.8) 25(37.9) 68(42.0)
1~10支/d 87(38.2) 21(31.8) 66(40.7)
>10支/d 48(21.1) 20(30.3) 28(17.3)
高血压家族史[例(%)] 31(13.6) 17(25.8) 14(8.6) 11.694 0.001
氧饱和度[%, M(Q1, Q3)] 86.5(83.0, 89.0) 86.5(83.4, 88.5) 86.5(83.0, 89.1) -0.751 0.452
心率(次/min, $\bar{x}±s$) 88.92±13.44 88.99±13.71 88.89±13.38 0.051 0.959
血脂异常[例(%)] 44(19.3) 19(28.8) 25(15.4) 5.371 0.020
高尿酸血症[例(%)] 59(25.9) 27(40.9) 32(19.8) 10.943 0.001
), ArticleFig(id=1200066183639696235, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200024243447624637, language=CN, label=表1, caption=

HTN组及 NTN组基线资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
指标 总体(n=228) HTN(n=66) NTN(n=162) Z/χ2/t P
年龄[岁, M(Q1, Q3)] 23.0(21.0, 27.0) 24.5(21.0, 28.0) 23.0(21.0, 26.3) -0.718 0.470
文化程度[例(%)] 0.004 0.950
大专以下 96(42.1) 28(42.4) 68(42.0)
大专及以上 132(57.9) 38(57.6) 94(58.0)
BMI[例(%)] 5.871 0.015
<24 kg/m2 179(78.5) 45(68.2) 134(82.7)
≥24 kg/m2 49(21.5) 21(31.8) 28(17.3)
SBP[mmHg, M(Q1, Q3)] 118.0(109.0, 124.0) 123.0(119.0, 132.0) 115.0(107.0, 121.0) -7.083 <0.001
DBP[mmHg, M(Q1, Q3)] 83.0(78.0, 91.0) 94.0(92.0, 98.3) 80.0(76.0, 83.0) -11.847 <0.001
中心性肥胖[例(%)] 31(13.6) 15(22.7) 16(9.9) 6.592 0.010
吸烟[例(%)] 4.947 0.084
0支/d 93(40.8) 25(37.9) 68(42.0)
1~10支/d 87(38.2) 21(31.8) 66(40.7)
>10支/d 48(21.1) 20(30.3) 28(17.3)
高血压家族史[例(%)] 31(13.6) 17(25.8) 14(8.6) 11.694 0.001
氧饱和度[%, M(Q1, Q3)] 86.5(83.0, 89.0) 86.5(83.4, 88.5) 86.5(83.0, 89.1) -0.751 0.452
心率(次/min, $\bar{x}±s$) 88.92±13.44 88.99±13.71 88.89±13.38 0.051 0.959
血脂异常[例(%)] 44(19.3) 19(28.8) 25(15.4) 5.371 0.020
高尿酸血症[例(%)] 59(25.9) 27(40.9) 32(19.8) 10.943 0.001
), ArticleFig(id=1200066183736165229, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200024243447624637, language=EN, label=Tab.2, caption=

Pittsburgh sleep quality index (PSQI) scores in HTN and NTN groups [M(Q1, Q3)]

, figureFileSmall=null, figureFileBig=null, tableContent=
指标

合计
(n=228)

HTN
(n=66)

NTN
(n=162)

 Z P
PSQI总分 4(2, 6) 7(6, 9) 3(1, 5) -9.049 <0.001
主观睡眠质量 1(1, 1) 1(1, 2) 1(0, 1) -5.473 <0.001
入睡时间 1(0, 1) 1(1, 2) 1(0, 1) -6.734 <0.001
睡眠时间 0(0, 1) 1(0, 2) 0(0, 1) -5.228 <0.001
睡眠效率 0(0, 1) 1(0, 1) 0(0, 0) -7.649 <0.001
睡眠障碍 1(0, 1) 1(1, 1) 1(0, 1) -5.652 <0.001
催眠药物 0(0, 0) 0(0, 0) 0(0, 0) 0.000 1.000
日间功能障碍 1(0, 2) 2(1, 2) 1(0, 1) -7.209 <0.001
), ArticleFig(id=1200066183861994350, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200024243447624637, language=CN, label=表2, caption=

HTN组和NTN组匹兹堡睡眠质量指数量表(PSQI)评分[M(Q1, Q3)]

, figureFileSmall=null, figureFileBig=null, tableContent=
指标

合计
(n=228)

HTN
(n=66)

NTN
(n=162)

 Z P
PSQI总分 4(2, 6) 7(6, 9) 3(1, 5) -9.049 <0.001
主观睡眠质量 1(1, 1) 1(1, 2) 1(0, 1) -5.473 <0.001
入睡时间 1(0, 1) 1(1, 2) 1(0, 1) -6.734 <0.001
睡眠时间 0(0, 1) 1(0, 2) 0(0, 1) -5.228 <0.001
睡眠效率 0(0, 1) 1(0, 1) 0(0, 0) -7.649 <0.001
睡眠障碍 1(0, 1) 1(1, 1) 1(0, 1) -5.652 <0.001
催眠药物 0(0, 0) 0(0, 0) 0(0, 0) 0.000 1.000
日间功能障碍 1(0, 2) 2(1, 2) 1(0, 1) -7.209 <0.001
), ArticleFig(id=1200066183966851955, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200024243447624637, language=EN, label=Tab.3, caption=

Clinical complications occurred in HTN group and NTN group in the past month

, figureFileSmall=null, figureFileBig=null, tableContent=
指标 合计(n=228) HTN(n=66) NTN(n=162) χ2 P
≥1种不适症状 129(56.6) 49(74.2) 80(49.4) 11.797 0.001
≥3种不适症状 40(17.5) 18(27.3) 22(13.6) 6.078 0.014
头晕 29(12.7) 20(30.3) 9(5.6) 25.870 0.000
头痛 20(8.8) 12(18.2) 8(4.9) 13.581 0.000
记忆力下降 51(22.4) 16(24.2) 35(21.6) 0.188 0.665
心慌 30(13.2) 14(21.2) 16(9.9) 5.273 0.022
胸闷 35(15.4) 12(18.2) 23(14.2) 0.573 0.449
食欲下降 24(10.5) 7(10.6) 17(10.5) 0.001 0.980
体重明显减轻 36(15.8) 6(9.1) 30(18.5) 3.135 0.077
疲乏 28(12.3) 14(21.2) 14(8.6) 6.878 0.009
耳鸣 6(2.6) 3(4.5) 3(1.9) - 0.359a
眩晕 11(4.8) 7(10.6) 4(2.5) - 0.015a
), ArticleFig(id=1200066184109458293, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200024243447624637, language=CN, label=表3, caption=

HTN组和NTN组近1个月伴随症状情况[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
指标 合计(n=228) HTN(n=66) NTN(n=162) χ2 P
≥1种不适症状 129(56.6) 49(74.2) 80(49.4) 11.797 0.001
≥3种不适症状 40(17.5) 18(27.3) 22(13.6) 6.078 0.014
头晕 29(12.7) 20(30.3) 9(5.6) 25.870 0.000
头痛 20(8.8) 12(18.2) 8(4.9) 13.581 0.000
记忆力下降 51(22.4) 16(24.2) 35(21.6) 0.188 0.665
心慌 30(13.2) 14(21.2) 16(9.9) 5.273 0.022
胸闷 35(15.4) 12(18.2) 23(14.2) 0.573 0.449
食欲下降 24(10.5) 7(10.6) 17(10.5) 0.001 0.980
体重明显减轻 36(15.8) 6(9.1) 30(18.5) 3.135 0.077
疲乏 28(12.3) 14(21.2) 14(8.6) 6.878 0.009
耳鸣 6(2.6) 3(4.5) 3(1.9) - 0.359a
眩晕 11(4.8) 7(10.6) 4(2.5) - 0.015a
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首次进入4500 m高原青年男性半年高血压发病情况及危险因素分析
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邓龙祥 1 , 张鹏天 2 , 周飞 1 , 袁铭 3, *
解放军医学杂志 | 临床研究 2023,48(9): 1081-1088
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解放军医学杂志 | 临床研究 2023, 48(9): 1081-1088
首次进入4500 m高原青年男性半年高血压发病情况及危险因素分析
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邓龙祥1, 张鹏天2, 周飞1, 袁铭3, *
作者信息
  • 1陆军第76集团军医院重症医学科，青海西宁 810007
  • 2陆军第76集团军医院检验科，青海西宁 810007
  • 3空军军医大学西京医院心血管内科，陕西西安 710032

    • 邓龙祥，医学硕士，主治医师，主要从事高血压疾病的诊治及冠状动脉介入治疗工作

通讯作者:

袁铭，E-mail：
Analysis of the prevalence and risk factors of hypertension in young men firstly entering the 4500 m plateau for half a year
Long-Xiang Deng1, Peng-Tian Zhang2, Fei Zhou1, Ming Yuan3, *
Affiliations
  • 1Department of Critical Care Medicine, the 76th Army Group Hospital, Xining, Qinghai 810007, China
  • 2Department of Clinical Laboratory, the 76th Army Group Hospital, Xining, Qinghai 810007, China
  • 3Department of Cardiology, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi 710032, China
出版时间: 2023-09-28 doi: 10.11855/j.issn.0577-7402.1485.2023.0320
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摘要
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目的 研究首次暴露于海拔4500 m地区并停留半年时间的青年男性高血压发病情况及其危险因素。方法 纳入由平原首次前往藏北海拔4500 m地区并停留半年时间的青年男性228例，根据血压情况分为高血压(HTN)组(n=66)与非高血压(NTN)组(n=162)。采用自制调查问卷、匹兹堡睡眠质量指数量表(PSQI)进行调查，并进行体格检查、实验室检测以了解高血压相关危险因素及伴随症状。采用多因素logistic回归分析高原高血压的危险因素及伴随症状的发生倾向。结果 228例中青年男性66例发生高血压，发病率为28.9%，其中Ⅰ级高血压52例，Ⅱ级高血压14例；单纯舒张期高血压58例，收缩压合并舒张压升高8例。HTN组肥胖及超重、中心性肥胖、吸烟>10支/d、高血压家族史、血脂异常、高尿酸血症的比例明显高于NTN组(P<0.05)，PSQI评分明显高于NTN组(P<0.001)。多因素logistic回归分析显示，高尿酸血症(P=0.02)、中心性肥胖(P=0.04)、高血压家族史(P=0.03)、PSQI评分(P<0.001)是高原高血压的独立危险因素。HTN组近1个月伴随不适症状的比例明显高于NTN组(P=0.001)，伴随3种及以上不适的占比也高于NTN组(P=0.01)，调整人口学差异后，HTN组伴随头晕及头痛的风险均高于NTN组(P<0.05)。结论 青年男性首次暴露于4500 m地区半年时间仍伴有较高的高血压发病率，主要为Ⅰ级高血压且以舒张压升高为主；高尿酸血症、中心性肥胖、高血压家族史、睡眠质量差是高原高血压的独立危险因素；高原高血压易引起多种不适，且伴随头晕、头痛的风险较高。

高血压  /  高海拔  /  危险因素  /  并发症

Objective To investigate the prevalence and risk factors of hypertension in young men first exposed to high altitude for half a year at 4500 m. Methods A total of 228 young men who firstly traveled from a plain area to an altitude of 4500 meters in northern Tibet and stayed there for six months were recruited in present study. They were divided into hypertension group (HTN, n=66) and non-hypertension group (NTN, n=162) based on their blood pressure status. A self-administered questionnaire, the Pittsburgh Sleep Quality Index (PSQI), physical examinations and laboratory tests were used to investigate the risk factors and clinical complications of hypertension. The general data and clinical complications of the two groups were compared, and multivariate logistic regression was used to analyze the risk factors of high-altitude hypertension and predisposition of clinical complications. Results Among the 228 individuals, 66 developed hypertension (incidence of 28.9%), including 52 cases of stage Ⅰ hypertension and 14 cases of stage Ⅱ hypertension. Fifty-eight individuals had isolated diastolic hypertension, and 8 individuals had combined systolic and diastolic hypertension. The proportions of obesity and overweight, central obesity, smoking over 10 cigarettes per day, family history of hypertension, dyslipidemia, and hyperuricemia were significantly higher in HTN group than those in NTN group (P<0.05). The PSQI score was also higher significantly in HTN group than that in NTN group (P<0.001). Multivariate logistic regression analysis showed that hyperuricemia (P=0.02), central obesity (P=0.04), family history of hypertension (P=0.03) and sleeping quality (P<0.001) were the independent risk factors for high-altitude hypertension. The proportion of clinical complications in the past month in HTN group was significantly higher than that in NTN group (P=0.001), and the proportion of three or more kinds of clinical complications was also higher in HTN group than that in NTN group (P=0.01). After adjusting for demographic differences, the risk of dizziness and headache in HTN group was higher than that in NTN group (P<0.05). Conclusions Young men firstly exposed to an altitude of 4500 meters still have a high incidence of hypertension after six months, mostly stage Ⅰ hypertension with diastolic pressure elevation; Hyperuricemia, central obesity, family history of hypertension, and poor sleep quality are the independent risk factors for high-altitude hypertension. High-altitude hypertension can cause various clinical complications, and the higher risk of accompanying dizziness and headache.

hypertension  /  high altitude  /  risk factors  /  complications
邓龙祥, 张鹏天, 周飞, 袁铭. 首次进入4500 m高原青年男性半年高血压发病情况及危险因素分析. 解放军医学杂志, 2023 , 48 (9) : 1081 -1088 . DOI: 10.11855/j.issn.0577-7402.1485.2023.0320
Long-Xiang Deng, Peng-Tian Zhang, Fei Zhou, Ming Yuan. Analysis of the prevalence and risk factors of hypertension in young men firstly entering the 4500 m plateau for half a year[J]. Medical Journal of Chinese People’s Liberation Army, 2023 , 48 (9) : 1081 -1088 . DOI: 10.11855/j.issn.0577-7402.1485.2023.0320
正文
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高血压是一种常见疾病，可导致心、脑、肾等多器官的损害，进而诱导心脑血管疾病、肾脏疾病的发生[1-3]。2018年我国18岁及以上居民的高血压患病率为27.5%，其中18~29岁、30~39岁患病率分别为8.9%、13.4%[4]。纵观多次全国范围内的抽样调查结果，我国高血压患病情况总体呈增高趋势，且青年群体不容忽视[5-6]。近年，来藏区务工、旅游者众多，每年均有大量青年出入高原，停留时间长短不等，而高海拔地区的低大气压、低氧、低气温等特殊气候条件，会对机体产生一系列影响。多项研究表明，高原环境会对人体血压的昼夜节律及动态变化产生明显影响，进而改变个体的适应进程[7-8]。目前有关高原环境对人体血压影响的研究多集中在急性适应期、较高海拔地区及全年龄段人群[9-10]，而着重关注青年群体、极高海拔地区和较长时间停留后血压改变及伴随症状的研究极少。本研究探讨了青年男性首次进入海拔4500 m地区并停留半年时间后的血压变化及相关伴随症状，以期为青年人群高原高血压的研究提供新证据。
1 资料与方法
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1.1 研究对象
于2020年1月-2022年1月通过街道义诊、固定接诊及同地区医院合作等方式收集由平原首次前往那曲和阿里地区(两地气候环境相近，平均海拔4500 m)并停留半年时间的青年男性228例。纳入标准：(1)既往无高原暴露史；(2)汉族青年男性(18~35岁)；(3)完成各项体格检查、睡眠及身体健康状况问卷调查；(4)既往体检无高血压或其他易影响血压的疾病；(5)近1个月内无频繁饮酒史(每日饮酒或经常性饮酒)；(6)高原暴露时间满足(6±1)个月，期间未返回平原地区。排除标准：(1)由于自身或客观原因，不能按时、按规范完成血液样本采集；(2)在入组至血液样本采集期间前往低海拔地区；(3)由于环境或人为因素导致血液样本损毁者。本研究已获空军军医大学西京医院伦理委员会审批(KY20213403-1号)。
1.2 研究方法
设计问卷调查表，收集研究对象的年龄、文化程度、吸烟情况、高血压家族史、个人史及近1个月自觉伴随的不适症状，如头晕、头痛、记忆力下降、心慌、胸闷、食欲下降等。
由经过培训的医师对研究对象的血压、身高、体重、腰围进行测量。测量血压时要求受试者在开始前30 min禁止饮酒、吸烟、饮用咖啡和运动，并在安静休息至少5 min后测量坐位右上臂血压，上臂置于心脏水平。使用合适规格的袖带，间隔5 min再次重复测量，结果取2次测量的平均值。如果2次读数相差5 mmHg以上，则测量第3次，结果取3次测量的平均值。对于测量中出现的极端值，再次进行测量并排除极端值。使用欧姆龙电子血压计(HEM-7201)进行血压测量，此款电子血压计对高原环境下的血压测量具有较高的准确性[11]。根据测得的血压结果将研究对象分为高血压(HTN)组(n=66)与非高血压(NTN)组(n=162)。血液标本抽取前要求研究对象禁食8 h，由专业的检验技师进行分析。
睡眠情况测评采用匹兹堡睡眠质量指数量表(PSQI)，该表适用于一般人的睡眠质量评估。刘贤臣等[12]于1996年验证了该评分标准对国人具有较好的信度和效度。PSQI量表共18个条目，划分为7个因子，各因子累积得分为PSQI总分，PSQI评分≥7分定义为存在睡眠障碍。
1.3 指标定义
肥胖及超重[13]定义为体重指数(BMI)≥24 kg/m2；中心性肥胖[14]定义为腰围≥85 cm；血脂异常[15]定义为高胆固醇血症和(或)高甘油三酯血症和(或)混合型高脂血症和(或)低HDL-C血症。高血压及高血压前期[6，16]：高血压定义为收缩压(SBP)≥140 mmHg和(或)舒张压(DBP)≥90 mmHg，或既往有高血压病史，目前正在服用降压药物治疗者；高血压前期定义为SBP 120~139 mmHg和(或)DBP 80~90 mmHg。高尿酸血症[17]定义为血清尿酸含量≥420 mmol/L。高血压家族史[18]定义为一级亲属(父母及兄弟姐妹)中有≥1人为高血压。
1.4 指标分析
收集研究对象的年龄、文化程度、吸烟情况、高血压家族史、血压、血脂异常、高尿酸血症等一般资料，以及近1个月自觉伴随的不适症状，比较HTN组与NTN组各指标的差异。采用多因素logistic回归分析组间的差异项并绘制森林图，以探讨高原高血压的危险因素，并评估其与各种不适症状之间的关系。
1.5 统计学处理
采用SPSS 26.0软件进行统计分析。计量资料呈正态分布时以$\bar{x}±s$表示，两组间比较采用t检验，呈偏态分布时以M(Q1，Q3)表示，两组间比较采用Mann-Whitney U检验；计数资料以例(%)表示，两组间比较采用χ2检验，对理论频数<1的组间比较采用Fisher确切概率法。采用多因素logistic回归分析高原高血压的危险因素并评估高血压与不适症状之间的关系。P<0.05为差异有统计学意义。
2 结果
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2.1 总体高血压发病情况
228例青年男性中发生高血压66例，发生率为28.9%，高血压前期101例，发生率为44.3%。分析罹患高血压的人群，Ⅰ级高血压52例，Ⅱ级高血压14例，无Ⅲ级高血压者。从血压升高的特点来看，单纯舒张压升高者58例，收缩压和舒张压同时升高者8例，无单纯收缩期高血压病例。
2.2 HTN组与NTN组的基线资料比较
两组在年龄、文化程度、吸烟、氧饱和度、心率等方面差异均无统计学意义。HTN组中吸烟者41例，其中>10支/d者20例，在吸烟人群占比为48.8%(20/41)，在组内占比30.3%(20/66)；NTN组中吸烟者94例，其中>10支/d者28例，在吸烟人群中占比29.8%(28/94)，在组内占比17.3%(28/162)。两组吸烟>10支/d的人数占比，不论在吸烟人群中或是各组内，差异均有统计学意义(P=0.034、P=0.029)(图1)。HTN组肥胖及超重、中心性肥胖、具有高血压家族史的比例均明显高于NTN组(P=0.015、P=0.010、P=0.001)。血液检测结果显示，HTN组血脂异常、高尿酸血症的比例均明显高于NTN组(P=0.020、P=0.001，表1)。
2.3 HTN组与NTN组PSQI评分比较
HTN组PSQI总分值为7(6，9)，NTN组PSQI总分值为3(1，5)，NTN组的总体睡眠质量明显好于HTN组(P<0.001)，且HTN组主观睡眠质量更差、入睡需要时间更长、睡眠效率低、睡眠障碍多、日间功能障碍更为明显(P<0.001)；两组均无口服药物治疗睡眠障碍的病例(表2)。
2.4 HTN组与NTN组近1个月伴随症状比较
HTN组中伴随≥1种不适症状的占比(74.2%，49/66)明显高于NTN组(49.4%，80/162，P=0.001)；HTN组中伴随≥3种不适症状的占比(27.3%，18/66)也明显高于NTN组(13.6%，22/162，P=0.014)。此外，HTN组伴随头晕(P<0.001)、头痛(P<0.001)、心慌(P=0.022)、疲乏(P=0.009)、眩晕(P=0.015)的比例也明显高于NTN组(表3)。针对每种症状，调整BMI、吸烟情况、血脂异常、高尿酸血症、睡眠质量等人口学混杂因素后发现，HTN组伴随头晕症状的风险是NTN组的6.013倍，伴随头痛的风险是NTN组的3.720倍；HTN组人群更不易发生明显的体重减轻(图2)。
2.5 影响高原高血压发生的多因素分析
以单因素分析中存在统计学差异的BMI、中心性肥胖、吸烟、高血压家族史、血脂异常、高尿酸血症、PSQI评分作为自变量进行二元logistic回归分析，结果显示，中心性肥胖、高血压家族史、高尿酸血症和PSQI评分是首次进入4500 m高原青年男性半年高原高血压发病的独立危险因素(图3)。
3 讨论
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现阶段，有关青年人群高血压疾病的研究已逐渐成为一个热点。既往Yang等[19]在中国南方地区选取19 254名15岁以上的研究对象，发现15~39岁人群高血压患病率为3.9%，高血压前期患病率为32.4%。Wei等[20]纳入吉林省德惠市3778名18岁以上的研究对象，发现18~44岁人群的高血压患病率为19.3%。本研究高血压发病率(28.9%)及高血压前期发病率(44.3%)均明显高于既往在平原地区开展的研究，提示在高海拔地区度过急性适应期直至半年左右时间后，青年人群的高原高血压发病情况仍不容乐观。高海拔地区对人体血压变化造成的影响及其机制已在多项研究中提及，肾素-血管紧张素-醛固酮(RAAS)系统的激活、血液黏滞度增加、内皮素活性增强、一氧化氮代谢异常等均参与了急性、亚急性暴露期及慢性适应期人体血压的调节[10，21]。一项前瞻性研究观察了9人于5260 m海拔高度停留9周时的血压情况，发现血压均明显升高，且以DBP升高为主[22]。此外，有研究对驻扎在海拔3550 m地区并度过1年时间的青年官兵的血压变化情况进行调查，结果发现急性期及12个月时的SBP水平均明显高于驻扎在海平面的官兵，且12个月时的DBP水平明显高于急性期及海平面水平[23]。以上结果均与本研究结论相似，而目前国内极高海拔地区较长时间停留的相关研究极少，本研究结果提示，对于首次到达高海拔地区并计划停留较长时间的青年人群，定期监测其血压很有必要。
多项研究提及肥胖和超重是高血压的独立危险因素[24-25]。肥胖和超重可通过激活交感神经系统和RASS系统、下调NO释放、影响内皮功能及氧化应激、调节瘦素及脂联素水平、增加胰岛素抵抗等方式对人体血压的调控产生影响[26]。本研究中虽然HTN组肥胖和超重人数占比多于NTN组，但多因素回归分析中并未得到类似结论。结合本研究实际考虑有以下原因：(1)筛选人群的差异，本研究纳入的对象为18~35岁青年人群，仅2人BMI>28 kg/m2；(2)纳入的样本量较小，可能导致误差。既往已有研究发现，肥胖个体的交感神经系统活性增强，血浆和尿去甲肾上腺素水平升高，中心性肥胖人群的交感神经活性高于外周性肥胖者，且交感神经激活与腰围或腰臀比直接相关[26-27]。本研究发现，中心性肥胖是高血压发病的独立危险因素，与既往国内研究[28]一致，而实际应用时大多结合中心性肥胖及BMI来评估高血压的发病风险。高血压疾病具有一定的家族遗传性，有家族遗传病史的人群其高血压的发病率往往高于无家族史者[29]。本研究HTN组中具有高血压家族史的人数占比明显高于NTN组，多因素回归分析也发现家族史是高血压发病的独立危险因素，与既往研究结果类似，提示对进入极高海拔地区的青年人群，可针对既往家族史特征来制定个性化的防范措施。
我国高尿酸血症的发病率总体呈逐年升高趋势，且高原地区食物摄入以牛羊肉为主，更易诱发高尿酸血症的发生。高尿酸血症可通过多种机制导致高血压[30-31]，当血尿酸升高到一定水平时可形成尿酸盐结晶，此类结晶沉积于血管内皮表面，通过氧化应激反应损伤血管内皮，激活血小板，引发局部血栓，进一步诱导内皮功能紊乱[32]；高尿酸血症还可激活肾素-血管紧张素系统，导致水钠潴留，升高血压；同时，溶解的尿酸盐可促进脂质过氧化，产生氧自由基，增强氧化应激及炎症反应；尿酸升高也会遏制NO的合成，引起血管内皮依赖性舒张障碍，促使血压升高。目前，已有研究发现高尿酸血症是高血压发病的独立危险因素。其中，PAMELA研究发现，血尿酸水平每增加1 mg/dl，发生家庭和日间高血压的风险均明显增加[33]；Kuwabara等[34]发现，较高的血尿酸水平是从高血压前期发展为高血压的高风险标志物。本研究中HTN组的高尿酸血症发病率明显高于NTN组，且高尿酸血症是高原高血压的独立危险因素，与上述研究结果相似。但本研究中HTN组高尿酸血症发病率高于既往Shen等[8]的研究(40.9% vs. 34.5%)，考虑为研究对象所处海拔更高(4500 m vs. 2700~3600 m)所致。以上研究结果提示，青年人群进入高原地区后应定期检测血尿酸水平，并合理控制高尿酸血症患者的尿酸水平。
睡眠质量的好坏与高血压的发生息息相关，睡眠不足或睡眠质量低下均可引起交感神经系统兴奋性升高，迷走神经兴奋性降低，同时也可使皮质醇和儿茶酚胺水平升高，从而引起心跳加快、心肌收缩力加强、心输出量增加，最终使血压升高[35]。多项研究证实，较低的睡眠质量往往更易伴随高血压的发生[36-37]。本研究发现，HTN组的PSQI总分明显高于NTN组，除两组均未服用药物治疗外，HTN组其余各项因子的得分均高于NTN组，提示对于首次暴露在高海拔地区的青年人群，应进行健康的睡眠管理，纠治影响睡眠的不良习惯和相关疾病。
目前，高海拔地区较长时间停留的研究多集中在肺动脉压升高方面[38-39]，而关于高原高血压及其伴随症状的研究鲜见。但结合既往研究，即使小幅度的血压改变对患者的临床预后也具有预测价值[7]，针对高原高血压及其伴随症状的研究十分必要。本研究采用问卷调查的方式，收集首次进入海拔4500 m地区并停留半年时间的青年男性近1个月自觉伴随的不适症状，发现以头晕、头痛、记忆力下降、心慌、胸闷、食欲下降、体重减轻、疲乏、耳鸣、眩晕等为主。目前通用的分类标准将高原疾病分为急性高山病、亚急性高山病、慢性高山病，此类疾病的诊断多采用症状结合体征，针对神经系统、循环系统、呼吸系统、消化系统等，通过“Lake Louise评分标准(LLS标准)”“青海标准”等进行评估诊断[39-40]。本研究实际收集到的临床不适与各类高山疾病的常见症状较为吻合，进行统计分析后发现，HTN组伴随不适症状的人数占比明显高于NTN组，伴随多种不适的比例也高于NTN组，且症状以头晕、头痛、心慌、疲乏、眩晕为主，而此类症状均为高血压的常见伴随症状[6]。在调整BMI、吸烟情况、血脂异常、高尿酸血症、睡眠质量等混杂因素后发现，HTN组伴随头晕症状的风险是NTN组的6.01倍，伴随头痛症状的风险是NTN组的3.720倍，且HTN组更不易发生体重减轻，与此前肥胖和超重、中心性肥胖是高血压人群的危险因素有一定联系，即高原高血压人群保持了较高的BMI及中心性肥胖比例。以上研究均提示，罹患高原高血压的人群往往伴随较多的临床不适，尤其易伴随头晕、头痛症状。由于高原高血压疾病可对人群的健康及生活质量产生较为明显的影响，即使大多仅归为Ⅰ级高血压，依旧不能轻视。
综上所述，本研究结果显示，青年男性首次暴露于海拔4500 m地区并停留半年时间后仍具有较高的高血压发病率，中心性肥胖、高血压家族史、高尿酸血症、睡眠质量可能是高原高血压的独立危险因素。本研究为青年群体高原高血压疾病的防治工作提供了参考，但仍存在一定的局限性：(1)仅对研究对象高原停留半年时的血压情况进行了监测，时间分布较为单一，不能体现血压随高原驻留时长而发生的动态变化，且研究采用的是即时血压监测，不能很好地反映血压昼夜节律的变化等情况；(2)由于极高海拔地区的极端气候条件，女性研究对象纳入困难，本研究仅针对青年男性群体，代表性有限；(3)睡眠质量评价并未采用多导睡眠监测，而是采用PSQI，结果可能存在一定的主观性。后续将继续以高原高血压为着力点，观察血压随高原驻留时长而发生的改变，并纳入24 h动态血压变化情况，以期为青年群体高原高血压的研究提供新的证据。
基金
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  • 陕西省社会发展计划重点研发项目(2021SF-324)
文献
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2023年第48卷第9期
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doi: 10.11855/j.issn.0577-7402.1485.2023.0320
  • 接收时间：2022-07-07
  • 首发时间：2025-11-25
  • 出版时间：2023-09-28
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  • 收稿日期：2022-07-07
  • 录用日期：2022-08-07
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Key Research and Development Projects for Social Development Planning in Shaanxi Province(2021SF-324)
陕西省社会发展计划重点研发项目(2021SF-324)
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    1陆军第76集团军医院重症医学科，青海西宁 810007
    2陆军第76集团军医院检验科，青海西宁 810007
    3空军军医大学西京医院心血管内科，陕西西安 710032

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袁铭，E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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