急性肾功能损伤在急性高原病发病过程中的差异研究

杨卫波; 李素芝; 高钰琪; 黄学文; 王宇亮; 杨帆; 黄河; 石泉贵; 牟庆梅; 陈雪梅

doi:10.16016/j.1000-5404.201710226

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急性肾功能损伤在急性高原病发病过程中的差异研究

临床医学 | 更新时间：2026-01-09

- 急性肾功能损伤在急性高原病发病过程中的差异研究
- Phenotypes of acute renal function injuries in different acute high-altitude diseases
- 第三军医大学学报 2018年40卷第12期页码：1109-1114
- 作者机构：
  
  1.400038，重庆，陆军军医大学(第三军医大学)高原军事医学系
  2.850007 拉萨，西藏军区总医院：全军高山病防治中心
  3.850007 拉萨，西藏军区总医院：检验科
- 作者简介：
  
  [ 李素芝，E-mail:suzhilixizang@163.com LI Suzhi, E-mail:suzhilixizang@163.com
- 基金信息：
  
  全军后勤科研“十二五”重大项目S(AWS14L005)
- DOI：10.16016/j.1000-5404.201710226
  中图分类号： R446.1;R594.3;R692
- 收稿：2017-10-31，
  
  修回：2017-12-01，
  
  纸质出版：2018-01
- 稿件说明：
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杨卫波, 李素芝, 高钰琪, 等. 急性肾功能损伤在急性高原病发病过程中的差异研究[J]. 第三军医大学学报, 2018,40(12):1109-1114.

Weibo YANG, Suzhi LI, Yuqi GAO, et al. Phenotypes of acute renal function injuries in different acute high-altitude diseases[J]. Journal of Third Military Medical University, 2018, 40(12): 1109-1114.
杨卫波, 李素芝, 高钰琪, 等. 急性肾功能损伤在急性高原病发病过程中的差异研究[J]. 第三军医大学学报, 2018,40(12):1109-1114. DOI： 10.16016/j.1000-5404.201710226.

Weibo YANG, Suzhi LI, Yuqi GAO, et al. Phenotypes of acute renal function injuries in different acute high-altitude diseases[J]. Journal of Third Military Medical University, 2018, 40(12): 1109-1114. DOI： 10.16016/j.1000-5404.201710226.

摘要

目的

探讨不同类型的急性高原病(acute high-altitude disease

AHAD)与肾功能损伤的关系。

方法

将2016-2017年间西藏军区总医院(海拔3 680m)高山科或ICU住院的249例AHAD患者设为病例组，具体分为：急性轻型高原病(acute mountain sickness

AMS)组(44例)、高原肺水肿(high-altitude pulmonary edema

HAPE)组(121例)、高原脑水肿(high-altitude cerebral edema

HACE)组(84例)，此外，将急性暴露于海拔3 680 m的健康人群设为对照组(60例)。病例组及对照组均在给予治疗前抽取静脉血，检测肾功能指标：血尿素氮(BUN)、血肌酐(Scr)、胱抑素C(CysC)、尿酸(UA)、内生肌酐清除率(Ccr)和二氧化碳结合力(CO

CP)；采集尿液，检测尿红细胞、尿白细胞、尿蛋白；记录尿量、血氧饱和度(SpO

)及预后情况。

结果

与AMS组和对照组相比，HAPE组和HACE组BUN、Scr、CysC、UA水平显著增高(

0.05)；但是AMS组与对照组之间BUN、Scr、CysC和UA水平差异无统计学意义(

0.05)；与HAPE组相比，HACE组BUN和Scr水平显著增高(

0.05)

。病例组和对照组人群均出现不同程度尿红细胞、尿白细胞，但组间比较差异无统计学意义(

0.05)。

结论

肾功能损伤的严重程度与急性高原病的类型密切相关，肾功能损伤常见于重症急性高原病患者，高原脑水肿组患者的肾功能损伤显著高于高原肺水肿组，损伤多处于肾功能代偿期。

Abstract

Objective

To investigate the phenotypes of acute renal injuries in different types of acute high-altitude disease (AHAD).

Methods

This study was conducted among a total of 249 patients with AHAD admitted in the General Hospital of Tibetan Military Command

Lhasa (altitude of 3 680 m) in the years from 2016 to 2017 (case group)

and 60 healthy volunteers with acute exposure to an altitude of 3 680 m served as the control group. In the case group

diagnoses of acute mountain sickness (AMS) were established in 44 patients

high altitude pulmonary edema (HAPE) in 121 patients and high altitude cerebral edema (HACE) in 84 patients. For all the participants

venous blood samples were drawn before treatment to test the renal function indexes including blood urea nitrogen (BUN)

serum creatinine (Scr)

cystatin C (CysC)

uric acid (UA)

creatinine clearance rate (Ccr) and carbon dioxide combining power (CO

CP). Urine red blood cell and white blood cell counts and urinary protein levels were tested by urine analysis

and the urine volume and pulse oxygen saturation (SpO

) were also recorded.

Results

The patients with HAPE and HACE had significantly higher levels of BUN

Scr

CysC and UA than those with AMS and the control subjects (

0.05)

and these parameters did not differ significantly between the latter 2 groups (

0.05). Compared with the patients with HAPE

the patients with HACE had significantly increased levels of BUN and Scr (

0.05). Low counts of urine red blood cells and white blood cells were detected in both the case group and the control group

without significant diff

erences between them (

0.05).

Conclusion

The severity of renal function injury varies among different types of AHAD. Renal function injury is common in patients with severe ADAH

and the functional impairment is often severer in HACE than in HAPE and is in the compensatory stage in most of the cases.

关键词

Keywords

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