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Article(id=1324044582471729280, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044540067328424, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202510145, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1760457600000, receivedDateStr=2025-10-15, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793606428019, onlineDateStr=2026-11-02, pubDate=1777046400000, pubDateStr=2026-04-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793606428019, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793606428019, creator=13701087609, updateTime=1793606428019, updator=13701087609, issue=Issue{id=1324044540067328424, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='8', pageStart='1345', pageEnd='1536', issueExtLink='null', onlineDate='null', pubDate='1777046400000', pubDateStr='2026-04-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793606417910, creator='13701087609', updateTime=1793606417910, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1387, endPage=1391, ext={EN=ArticleExt(id=1324044582966657153, articleId=1324044582471729280, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between altitude and hypertension among Xizang residents: The mediating role of HB, columnId=1228016570660745413, journalTitle=Modern Preventive Medicine, columnName=Environmental and Occupational Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the association between altitude and the prevalence of hypertension among residents of Tibet, and to analyze potential mediating factors.

Methods

Residents aged 18 and above who had lived in Tibet for 6 months or longer were selected through a multi-stage stratified cluster random sampling method to participate in questionnaire surveys, physical measurements, and laboratory tests. Multivariable logistic regression was employed to explore the association between altitude and hypertension. The mediating roles of hemoglobin were further analyzed.

Results

A total of 3 085 participants were included, among whom 1 062(34.42%) were diagnosed with hypertension. After adjusting for covariates, the multivariable logistic regression showed that for every 1 000 m increase in altitude, the risk of hypertension increased by 42% (OR=1.42, 95%CI: 1.16-1.73, P<0.05). Compared with residents living at altitudes below 3 500 m, those at 3 500-<4 000 m and≥4 000 m had ORs of 1.37 and 1.61 for hypertension risk, respectively, with a significant linear trend (P for trend <0.05). Mediation analysis indicated that hemoglobin significantly mediated the association between altitude and hypertension, with mediation effect proportions of 17.80% (95%CI: 3.10%-32.60%, P<0.05).

Conclusion

Altitude is positively associated with the risk of hypertension among residents in Tibet. It is recommended to strengthen the monitoring of blood pressure and hemoglobin levels in populations living at high altitudes, in order to reduce the risk of hypertension.

, authors=Zhuoga Basang1, Yangji Gesang1, Guo-xia BAI1, Yan SUN2, authorsList=Zhuoga Basang, Yangji Gesang, Guo-xia BAI, Yan SUN, authorCompany=null, correspAuthors=Yan SUN, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324044587190321294, articleId=1324044582471729280, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=海拔与西藏居民高血压的关联：血红蛋白的中介作用, columnId=1228016571273113811, journalTitle=现代预防医学, columnName=环境与职业卫生, runingTitle=null, highlight=null, articleAbstract=
目的

探讨海拔与西藏居民高血压患病的关联，并分析潜在的中介因素。

方法

采用多阶段分层整群随机抽样方法抽取在西藏居住6个月及以上的18岁及以上居民进行问卷调查、身体测量和实验室检查，采用多因素logistic回归分析探讨海拔与高血压患病的关联性，并分析血红蛋白的中介作用。

结果

共纳入3 085人，检出高血压患者1 062人（34.42%）。调整其他协变量后，多因素logistic回归分析结果显示海拔每增长1 000 m，高血压患病风险增加42%（OR=1.42，95%CI：1.16~1.73，P<0.05）；与居住地海拔<3 500 m相比，海拔3 500~<4 000 m和≥4 000 m者高血压患病风险的OR值分别是1.37和1.61，且存在线性关系（P趋势<0.05）。中介分析显示血红蛋白在海拔与高血压患病之间的关联中有中介效应，中介效应占比为17.80%（95%CI：3.10%~32.60%，P<0.05）。

结论

海拔高度与西藏居民高血压患病风险正相关，建议加强对高海拔地区居民血压和血红蛋白水平的关注，降低高血压的患病风险。

, authors=巴桑卓嘎1, 格桑央吉1, 白国霞1, 孙燕2, authorsList=巴桑卓嘎, 格桑央吉, 白国霞, 孙燕, authorCompany=null, correspAuthors=孙燕, authorNote=

巴桑卓嘎（1988—），女，本科，主管医师，研究方向：慢性病与营养监测

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孙燕，E-mail：
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巴桑卓嘎（1988—），女，本科，主管医师，研究方向：慢性病与营养监测

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language=CN, orderNo=3, keyword=血红蛋白), Keyword(id=1324044590956806319, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044582471729280, language=CN, orderNo=4, keyword=中介作用)], refs=[Reference(id=1324044592080879799, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044582471729280, doi=null, pmid=null, pmcid=null, year=2020, volume=75, issue=2, pageStart=285, pageEnd=292, url=null, language=null, rfNumber=[1], rfOrder=0, authorNames=Fuchs FD, Whelton PK, journalName=Hypertension, refType=null, unstructuredReference=Fuchs FD, Whelton PK. 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Journal of Clinical Hypertension (Greenwich, Conn.), 2024, 26(1): 17-23., articleTitle=Association between hemoglobin concentration and hypertension risk in native Tibetans at high altitude, refAbstract=null)], funds=[Fund(id=1324044591971827894, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044582471729280, awardId=XZ202501ZR0125, language=CN, fundingSource=西藏自治区自然科学基金面上项目(XZ202501ZR0125), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324044587471339663, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044582471729280, xref=1., ext=[AuthorCompanyExt(id=1324044587488116880, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044582471729280, companyId=1324044587471339663, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Tibet Center for Disease Control and Prevention, Lhasa, Tibet 850000, China), AuthorCompanyExt(id=1324044587496505489, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044582471729280, companyId=1324044587471339663, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.西藏自治区疾病预防控制中心，西藏　拉萨　850000)]), AuthorCompany(id=1324044587597168786, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044582471729280, xref=2., ext=[AuthorCompanyExt(id=1324044587609751699, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044582471729280, companyId=1324044587597168786, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.拉萨市疾病预防控制中心健康教育科)])], figs=[ArticleFig(id=1324044591116189872, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044582471729280, language=EN, label=Fig. 1, caption=Mediation effect analysis of hemoglobin, figureFileSmall=OERp9UlPTx8EBodws2ZZOA==, figureFileBig=2+I38TiiQYaxZrSPH+kg7g==, tableContent=null), ArticleFig(id=1324044591208464561, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044582471729280, language=CN, label=图1, caption=血红蛋白的中介效应分析

注：模型调整年龄、性别、受教育程度、城乡、吸烟、二手烟暴露、饮酒、身体活动、睡眠障碍、午休、高血压家族史、烹饪燃料、体质指数和膳食模式得分。

, figureFileSmall=OERp9UlPTx8EBodws2ZZOA==, figureFileBig=2+I38TiiQYaxZrSPH+kg7g==, tableContent=null), ArticleFig(id=1324044591439151282, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044582471729280, language=EN, label=Table 1, caption=

Distribution of hypertension by different characteristics

, figureFileSmall=null, figureFileBig=null, tableContent=
特征合计（n=3 086）非高血压患者（n=2 024）高血压患者（n=1 062）χ2值/t值P值
年龄[岁，（）]48.81±13.5844.91±12.8556.25±11.69-198.195<0.001
性别（%）17.220<0.001
男1 303（42.22）800（39.53）503（47.36）
女1 783（57.78）1 224（60.47）559（52.64）
受教育程度（%）106.429<0.001
文盲1 161（37.62）685（33.84）476（44.82）
小学849（27.51）541（26.73）308（29.00）
初中566（18.34）366（18.08）200（18.83）
高中及以上510（16.53）432（21.34）78（7.34）
城乡（%）0.0930.730
城镇1 591（51.56）1 048（51.78）543（51.13）
农村1 495（48.44）976（48.22）519（48.87）
吸烟（%）8.6170.013
现在吸烟402（13.03）287（14.18）115（10.83）
戒烟208（6.74）126（6.23）82（7.72）
从不吸烟2 476（80.23）1 611（79.59）865（81.45）
二手烟暴露（%）1.1020.280
是1 279（41.45）853（42.14）426（40.11）
否1 807（58.55）1 171（57.86）636（59.89）
饮酒（%）14.212<0.001
经常饮酒724（23.46）452（22.33）272（25.61）
偶尔饮酒704（22.81）502（24.80）202（19.02）
不饮酒1 658（53.73）1 070（52.87）588（55.37）
午休（%）0.1220.710
有454（14.71）294（14.53）160（15.07）
无2 632（85.29）1 730（85.47）902（84.93）
睡眠障碍（%）46.836<0.001
有1 821（59.01）1 105（54.59）716（67.42）
无1 265（40.99）919（45.41）346（32.58）
高血压家族史（%）24.102<0.001
有736（23.85）427（21.10）309（29.10）
无2 350（76.15）1 597（78.90）753（70.90）
烹饪燃料（%）0.3820.520
清洁1 005（32.57）651（32.16）354（33.33）
固体2 081（67.43）1 373（67.84）708（66.67）
体质指数（%）65.160<0.001
消瘦/正常1 463（47.41）1 058（52.27）405（38.14）
超重1 016（32.92）633（31.27）383（36.06）
肥胖607（19.67）333（16.45）274（25.80）
身体活动（%）0.1800.672
正常2 611（84.61）1 717（84.83）894（84.18）
不足475（15.39）307（15.17）168（15.82）
膳食模式得分[分，（）]23.37±5.0523.75±5.0722.63±4.94-248.057<0.001
海拔[m，（）]3 832.90±487.593 816.90±487.613 863.38±486.32-436.6470.001
血红蛋白[g/L，（）]160.93±27.21158.49±26.83165.58±27.32-327.839<0.001
), ArticleFig(id=1324044591577563315, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044582471729280, language=CN, label=表1, caption=

不同特征人群高血压分布情况

, figureFileSmall=null, figureFileBig=null, tableContent=
特征合计（n=3 086）非高血压患者（n=2 024）高血压患者（n=1 062）χ2值/t值P值
年龄[岁，（）]48.81±13.5844.91±12.8556.25±11.69-198.195<0.001
性别（%）17.220<0.001
男1 303（42.22）800（39.53）503（47.36）
女1 783（57.78）1 224（60.47）559（52.64）
受教育程度（%）106.429<0.001
文盲1 161（37.62）685（33.84）476（44.82）
小学849（27.51）541（26.73）308（29.00）
初中566（18.34）366（18.08）200（18.83）
高中及以上510（16.53）432（21.34）78（7.34）
城乡（%）0.0930.730
城镇1 591（51.56）1 048（51.78）543（51.13）
农村1 495（48.44）976（48.22）519（48.87）
吸烟（%）8.6170.013
现在吸烟402（13.03）287（14.18）115（10.83）
戒烟208（6.74）126（6.23）82（7.72）
从不吸烟2 476（80.23）1 611（79.59）865（81.45）
二手烟暴露（%）1.1020.280
是1 279（41.45）853（42.14）426（40.11）
否1 807（58.55）1 171（57.86）636（59.89）
饮酒（%）14.212<0.001
经常饮酒724（23.46）452（22.33）272（25.61）
偶尔饮酒704（22.81）502（24.80）202（19.02）
不饮酒1 658（53.73）1 070（52.87）588（55.37）
午休（%）0.1220.710
有454（14.71）294（14.53）160（15.07）
无2 632（85.29）1 730（85.47）902（84.93）
睡眠障碍（%）46.836<0.001
有1 821（59.01）1 105（54.59）716（67.42）
无1 265（40.99）919（45.41）346（32.58）
高血压家族史（%）24.102<0.001
有736（23.85）427（21.10）309（29.10）
无2 350（76.15）1 597（78.90）753（70.90）
烹饪燃料（%）0.3820.520
清洁1 005（32.57）651（32.16）354（33.33）
固体2 081（67.43）1 373（67.84）708（66.67）
体质指数（%）65.160<0.001
消瘦/正常1 463（47.41）1 058（52.27）405（38.14）
超重1 016（32.92）633（31.27）383（36.06）
肥胖607（19.67）333（16.45）274（25.80）
身体活动（%）0.1800.672
正常2 611（84.61）1 717（84.83）894（84.18）
不足475（15.39）307（15.17）168（15.82）
膳食模式得分[分，（）]23.37±5.0523.75±5.0722.63±4.94-248.057<0.001
海拔[m，（）]3 832.90±487.593 816.90±487.613 863.38±486.32-436.6470.001
血红蛋白[g/L，（）]160.93±27.21158.49±26.83165.58±27.32-327.839<0.001
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Logistic regression analysis of the association between altitude and hypertension prevalence

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海拔β值Se值OR值（95%CI）P值
连续型变量（每增长1 000m）0.3470.1021.42（1.16，1.73）<0.001
分类变量
<3500 m1.00
3 500~<4 000 m0.3140.1531.37（1.03，1.84）0.032
≥4 000 m0.4740.1451.61（1.21，2.14）0.001
P趋势<0.001
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海拔与高血压患病关联的logistic回归分析

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海拔β值Se值OR值（95%CI）P值
连续型变量（每增长1 000m）0.3470.1021.42（1.16，1.73）<0.001
分类变量
<3500 m1.00
3 500~<4 000 m0.3140.1531.37（1.03，1.84）0.032
≥4 000 m0.4740.1451.61（1.21，2.14）0.001
P趋势<0.001
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海拔与西藏居民高血压的关联：血红蛋白的中介作用
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巴桑卓嘎 1 , 格桑央吉 1 , 白国霞 1 , 孙燕 2
现代预防医学 | 环境与职业卫生 2026,53(8): 1387-1391
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现代预防医学 |环境与职业卫生 2026 , 53 (8) : 1387 -1391
海拔与西藏居民高血压的关联：血红蛋白的中介作用
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巴桑卓嘎1, 格桑央吉1, 白国霞1, 孙燕2
作者信息
  • 1.西藏自治区疾病预防控制中心，西藏　拉萨　850000
  • 2.拉萨市疾病预防控制中心健康教育科
通讯作者:
孙燕，E-mail：
作者简介:

巴桑卓嘎（1988—），女，本科，主管医师，研究方向：慢性病与营养监测

Association between altitude and hypertension among Xizang residents: The mediating role of HB
Zhuoga Basang1, Yangji Gesang1, Guo-xia BAI1, Yan SUN2
Affiliations
  • Tibet Center for Disease Control and Prevention, Lhasa, Tibet 850000, China
出版时间: 2026-04-25 doi: 10.20043/j.cnki.MPM.202510145
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摘要
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目的

探讨海拔与西藏居民高血压患病的关联，并分析潜在的中介因素。

方法

采用多阶段分层整群随机抽样方法抽取在西藏居住6个月及以上的18岁及以上居民进行问卷调查、身体测量和实验室检查，采用多因素logistic回归分析探讨海拔与高血压患病的关联性，并分析血红蛋白的中介作用。

结果

共纳入3 085人，检出高血压患者1 062人（34.42%）。调整其他协变量后，多因素logistic回归分析结果显示海拔每增长1 000 m，高血压患病风险增加42%（OR=1.42，95%CI：1.16~1.73，P<0.05）；与居住地海拔<3 500 m相比，海拔3 500~<4 000 m和≥4 000 m者高血压患病风险的OR值分别是1.37和1.61，且存在线性关系（P趋势<0.05）。中介分析显示血红蛋白在海拔与高血压患病之间的关联中有中介效应，中介效应占比为17.80%（95%CI：3.10%~32.60%，P<0.05）。

结论

海拔高度与西藏居民高血压患病风险正相关，建议加强对高海拔地区居民血压和血红蛋白水平的关注，降低高血压的患病风险。

海拔  /  高血压  /  血红蛋白  /  中介作用
Objective

To investigate the association between altitude and the prevalence of hypertension among residents of Tibet, and to analyze potential mediating factors.

Methods

Residents aged 18 and above who had lived in Tibet for 6 months or longer were selected through a multi-stage stratified cluster random sampling method to participate in questionnaire surveys, physical measurements, and laboratory tests. Multivariable logistic regression was employed to explore the association between altitude and hypertension. The mediating roles of hemoglobin were further analyzed.

Results

A total of 3 085 participants were included, among whom 1 062(34.42%) were diagnosed with hypertension. After adjusting for covariates, the multivariable logistic regression showed that for every 1 000 m increase in altitude, the risk of hypertension increased by 42% (OR=1.42, 95%CI: 1.16-1.73, P<0.05). Compared with residents living at altitudes below 3 500 m, those at 3 500-<4 000 m and≥4 000 m had ORs of 1.37 and 1.61 for hypertension risk, respectively, with a significant linear trend (P for trend <0.05). Mediation analysis indicated that hemoglobin significantly mediated the association between altitude and hypertension, with mediation effect proportions of 17.80% (95%CI: 3.10%-32.60%, P<0.05).

Conclusion

Altitude is positively associated with the risk of hypertension among residents in Tibet. It is recommended to strengthen the monitoring of blood pressure and hemoglobin levels in populations living at high altitudes, in order to reduce the risk of hypertension.

Altitude  /  Hypertension  /  Hemoglobin  /  Mediation
巴桑卓嘎, 格桑央吉, 白国霞, 孙燕. 海拔与西藏居民高血压的关联：血红蛋白的中介作用. 现代预防医学, 2026 , 53 (8) : 1387 -1391 . DOI: 10.20043/j.cnki.MPM.202510145
Zhuoga Basang, Yangji Gesang, Guo-xia BAI, Yan SUN. Association between altitude and hypertension among Xizang residents: The mediating role of HB[J]. Modern Preventive Medicine, 2026 , 53 (8) : 1387 -1391 . DOI: 10.20043/j.cnki.MPM.202510145
正文
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高血压是心血管疾病最常见的可变危险因素之一，显著增加了中风、心力衰竭、心肌梗死、终末期肾病、CVD相关死亡率和全因死亡率的风险[1]。据估计，全球约14亿人患有高血压[2]，疾病负担沉重。高血压病因复杂，除年龄、遗传和生活方式等传统因素外，独特的环境暴露如高海拔缺氧的作用日益受到关注。然而，当前关于海拔与高血压关联的流行病学证据并不一致。例如，喜马拉雅高原地区的居民高血压患病率相对较高，且随着海拔的升高呈现上升趋势，但在南美安第斯高原却观察到相反的模式[3]。这种地理异质性提示，海拔对血压的影响可能并非直接作用，而是通过一系列中间生理病理过程实现。在此背景下，探寻连接海拔暴露与高血压结局的关键中介机制，成为理解上述差异和制定针对性干预策略的核心。基于高原生理学与心血管病理学的研究结果显示，海拔升高会增加高原地区居民血红蛋白[4]，而血红蛋白与高血压的患病风险正相关[5-6]。因此，血红蛋白可能在海拔与高血压的关联中起中介作用。然而，这一中介通路在人群研究，特别是在西藏这一典型高海拔人群中的效应大小如何，尚未有研究同时予以量化验证。西藏地处青藏高原，是我国高血压患病率较高的地区之一[7]。厘清海拔影响当地居民健康的具体机制具有重要的公共卫生意义。为此，本研究旨在西藏成年常住居民中，首先确认居住地海拔与高血压患病风险的关联，进而重点评估血红蛋白在其中的中介效应大小，以期为高原地区高血压的机制阐释和风险防控提供新的流行病学证据。
1　对象与方法
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1.1　对象
在西藏居住6个月及以上的18岁及以上常住居民。按照2023年中国居民慢性病与危险因素监测方案[8]要求，西藏共有6个监测点，分别是拉萨市城关区（平均海拔3 650 m）、拉萨市墨竹工卡县（平均海拔3 800 m）、林芝市米林市（平均海拔2 950 m）、日喀则市江孜县（平均海拔4 040 m）、日喀则市桑珠孜区（平均海拔3 836 m、）和山南市乃东区（平均海拔3 560 m）。采用多阶段分层整群随机抽样的方法选择调查对象，在每个监测点抽取3个乡镇（街道），每个乡镇（街道）抽取2个行政村（居委会），每个行政村（居委会）抽取不少于45户居民进行调查，每个监测点调查不少于600人。调查对象纳入标准为在当地居住6个月及以上的常住居民、年龄≥18岁、无重大精神疾患、愿意参与此次调查并签署知情同意书。于2023年11月-2024年7月共调查3 634人，去除人口学特征、身高、体重、血压、居住地海拔、血红蛋白等数据缺失者，最终纳入3 086人进行分析，其中拉萨市城关区、拉萨市墨竹工卡县、林芝市米林市、日喀则市江孜县、日喀则市桑珠孜区、山南市乃东区样本量分别为451人、505人、557人、433人、556人和584人，各监测点样本量相对均衡，平均海拔覆盖范围从2 950 m至4 040 m，具有较好的地理与环境梯度代表性。本研究通过中国疾病预防控制中心伦理审查委员会审查（批号：202305），所有调查对象均签署知情同意书。
1.2　方法
1.2.1　问卷调查
由培训合格且熟悉当地语言的调查员进行面对面询问调查，问卷内容包括人口学特征、慢性病的患病、控制情况及家族史、吸烟、饮酒、饮食习惯和身体活动状况等。
1.2.2　身体测量
由调查员按照人体健康监测人体测量方法（WS/T424-2013）要求集中进行，测量指标包括身高、体重、血压等。身高测量采用金属立柱式身高计，体重测量采用电子体重秤，血压测量采用欧姆龙HBP1300/1320型电子血压计，血压总共测量3次，每次测量间隔1分钟，计算3次测量结果的平均值来判断高血压患病情况。
1.3　定义及标准
1.3.1　结局变量（因变量）
高血压：定义为收缩压≥140 mmHg，和/或舒张压≥90 mmHg，和/或被乡镇级及以上医院明确诊断患有高血压[9]。
1.3.2　主要暴露变量（自变量）
居住地海拔：基于调查对象提供的详细居住地址（具体到行政村/居委会），通过调用国家地理信息公共服务平台（天地图）的应用程序接口（API），获取该地址对应的海拔高度数据，所有海拔数据均以米（m）为单位记录。
1.3.3　中介变量
采集调查对象的指尖血，采用HemoCue法现场测定血红蛋白，单位为g/L。
1.3.4　协变量
基于前期相关文献[10]，本研究纳入以下协变量进行调整，其中人口学特征包括年龄（岁，连续型）、性别（男/女）、受教育程度（文盲、小学、初中、高中及以上）、城乡（城镇/农村）；生活方式与行为包括吸烟状况（现在吸烟、戒烟、从不吸烟）、二手烟暴露（是/否，定义为每周至少1天暴露[11]）、饮酒状况（经常饮酒、偶尔饮酒、不饮酒）[12]、身体活动水平（正常/不足，依据总活动时间是否达到每周150分钟中等强度当量定义[8]）、睡眠障碍（是/否，出现睡眠打鼾、入睡困难、早醒并难以重新入睡、白天困倦、药物辅助睡眠、夜间觉醒2次或以上等任一症候定义为睡眠障碍[13]）、午休习惯（有/无，中午休息时间>0分钟为有午休[11]）、膳食模式得分（基于得舒饮食原则计算[14]，为连续型变量）。健康状况与家族史包括高血压家族史（是/否）、体质指数（BMI，kg/m2，分为消瘦/正常、超重、肥胖三类，BMI≥28.0为肥胖，24.0~27.9为超重[15]）；环境因素包括家庭烹饪燃料类型（清洁燃料/固体燃料，煤炭、动物粪便、木柴被定义为固体燃料，液化石油、天然气、电力、沼气被定义为清洁燃料[16]）。
1.4　统计学分析
采用R 4.2.1软件进行统计学分析，计量资料以表示，组间比较采用独立样本t检验，计数资料以频数（构成比）表示，组间比较采用χ2检验。以是否患高血压为因变量，以居住地海拔（连续型变量和分类变量）为自变量，进行多因素logistic回归分析，探讨海拔与高血压患病的关联性。本研究使用R语言中“lavaan”包进行基于结构方程模型的中介效应分析方法探讨血红蛋白在居住地海拔与高血压患病风险关联的中介效应。双侧检验，P<0.05为差异有统计学意义。
2　结果
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2.1　一般情况
本次共纳入3 086人，平均年龄为（48.81±13.58）岁；男性1 303人，占42.22%；城镇1 591人，占51.56%；受教育程度中文盲有1 161人，占37.62%，小学有849人，占27.51%，初中有566人，占18.34%。高血压患者中居住地海拔、血红蛋白水平均高于非高血压患者（均P<0.05）。不同年龄、性别、受教育程度、吸烟、饮酒、睡眠障碍、高血压家族史、膳食模式得分、体质指数的调查对象高血压检出情况存在统计学差异（均P<0.05）。见表1。
2.2　海拔与高血压患病的关联分析
在调整年龄、性别、受教育程度、城乡、吸烟、二手烟暴露、饮酒、睡眠障碍、午休、高血压家族史、烹饪燃料、体质指数、膳食模式得分和身体活动后，海拔作为连续型变量时，海拔每增长1 000 m，高血压患病风险增加42%（OR=1.42，95%CI：1.16~1.73，P<0.05）；海拔作为分类变量时，与居住地海拔<3 500 m相比，海拔3 500~<4 000 m和≥4 000 m者高血压患病风险的OR值分别是1.37和1.61，且存在线性关系（P趋势<0.05）。见表2。
2.3　血红蛋白的中介效应
将居住地海拔作为连续型自变量（每增长1 000 m），高血压患病作为因变量，血红蛋白作为中介变量进行中介分析。在调整上述协变量后，血红蛋白在海拔与高血压患病之间的关联中有中介效应，即居住地海拔升高通过提高血红蛋白水平而增加高血压的患病风险，中介效应占比为17.80%（95%CI：3.10%，32.60%，P<0.05）。见图1。
3　讨论
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高血压是最常见的慢性疾病之一，虽然年龄、性别、遗传和不健康的生活方式等因素是高血压发生、发展的已知危险因素，但目前的证据表明，这些因素仅部分解释了高血压的病因。因此，深入了解高血压及其相关因素可能有助于高血压的防控。本研究结果显示，海拔与西藏居民高血压患病之间存在线性的正相关关系，且血红蛋白在其中起到中介作用，居住地海拔升高可通过提高血红蛋白水平而增加高血压的患病风险。
目前关于海拔与高血压关联的研究结果尚不一致，在尼泊尔开展的一项研究显示，海拔与高血压呈现正相关[17]。而另一项针对高原地区居民高血压患病率与海拔关系的系统综述和荟萃分析结果显示，藏族受试者在高海拔地区更容易发生高血压，且海拔高度与高血压患病率之间的正向关系仅在西藏居民中发现[3]。本研究结果显示，海拔高度与西藏居民高血压患病风险正相关，这可能与不同研究中的调查对象、调查地区海拔和环境等不同有关，提示海拔对高血压的作用是相对复杂的，需进一步结合基因组学和代谢组学进行深入研究。此外，研究结果显示海拔与高血压患病之间的关联呈现出线性特征，与Yuewen Zhang等[18]研究结果一致，提示随着海拔的升高，高血压患病风险增加。值得注意的是，同在西藏地区开展的Song等人[19]的研究报告显示，在仅调整年龄和性别后，高血压患病率随海拔升高而降低。这种表面上的矛盾，揭示了海拔影响健康的复杂性与多维性，可能与未充分控制的混杂因素有关。Song等人的研究未对BMI、膳食、体力活动、吸烟饮酒等生活方式因素进行调整。已知这些因素与高血压风险密切相关，且其分布很可能随海拔梯度和城乡差异而系统性变化，例如，高海拔地区居民可能有更低的BMI和不同的饮食模式。这些未被控制的保护性因素，可能在简单模型中掩盖了海拔作为生理性应激源的真实风险效应。两项研究的结果共同指向一个更复杂的图景，海拔高度作为一个环境暴露，其净健康效应是固有的生理性升压风险与伴随的地理-社会-生活方式因素、以及人群遗传适应能力之间动态平衡的结果。本研究通过尽可能全面的协变量控制，更侧重于揭示前者的独立贡献；而Song等人的结果可能更多地反映了在特定人群和环境下，后两者（保护性生活方式和适应能力）所起的优势作用。未来需要前瞻性队列研究来厘清这些因素随时间变化的相互作用，并利用孟德尔随机化等方法进一步验证海拔与高血压的因果关联。
关于海拔对高血压的作用机制，有研究认为高原地区居民长期暴露在低压、缺氧的环境中可能会导致一系列生理变化，包括心血管系统的适应和不适应，如最大心率和血压调节的降低，心输出量和血量的变化，以及肺动脉和外周动脉的重塑等[20]。也有研究认为与高海拔地区高寒气候有关，暴露在寒冷的温度下会导致血管收缩和交感神经系统活动增加，并降低内皮功能，这可能会导致血压升高[21]。一项系统综述分析结果显示，较低的环境温度会增加成年人的血压[22]。
研究结果显示，居住地海拔与高血压风险之间的关联可能由血红蛋白水平介导。国内外研究指出，海拔升高会增加高原地区居民血红蛋白水平[4]，而血红蛋白与高血压的患病风险呈正相关[5-6]，这表明，海拔升高可能通过提升血红蛋白水平进而增加高血压的患病风险。因此，在高原地区健康管理中，应重点关注居民的血红蛋白水平，以降低高血压的患病风险。关于血红蛋白的中介机制，有研究认为长期高原缺氧诱导的代偿性红细胞增多及血红蛋白浓度升高，是机体提高携氧能力的关键适应，然而，过高的血红蛋白水平可能导致血流动力学和血管功能异常[23]。主要表现在，一是血粘度增高，增加外周血管阻力，直接导致血压上升；二是促进血小板聚集与血栓形成倾向，间接损害血管内皮功能；三是血红蛋白分解过程中释放的自由基（如血红素、铁离子）可通过氧化应激途径损伤血管内皮，减少一氧化氮的生物利用度，导致血管舒张功能障碍。这些机制共同构成了高原缺氧到血红蛋白升高，再经由血液高凝、高粘及内皮损伤功能障碍最终导致高血压的潜在通路。
本研究存在局限性，首先，本研究属于横断面研究，研究因素与结论的关系是探索性的，其因果关系需要进一步通过前瞻性研究予以确认；其次，考虑到机体对于高海拔环境存在逐渐适应的过程，居住年限对高血压患病可能有一定的影响，因本研究未收集相关信息而未纳入调整；最后，本研究在青藏高原地区开展，具有一定的独特性，研究结果推断到其他高原地区可能不适用。
本研究揭示了居住地海拔高度与西藏居民高血压之间的正向关系，强调了血红蛋白的重要中介作用，为西藏居民高血压防控工作提供了科学依据。建议加强对高海拔地区居民血压和血红蛋白水平的关注，降低高血压的患病风险。
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  • 西藏自治区自然科学基金面上项目(XZ202501ZR0125)
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2026年第53卷第8期
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doi: 10.20043/j.cnki.MPM.202510145
  • 接收时间：2025-10-15
  • 首发时间：2026-11-02
  • 出版时间：2026-04-25
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  • 收稿日期：2025-10-15
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西藏自治区自然科学基金面上项目(XZ202501ZR0125)
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    1.西藏自治区疾病预防控制中心，西藏　拉萨　850000
    2.拉萨市疾病预防控制中心健康教育科

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total species (%)		 属
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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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