移居高原男性青年慢性高山病的诊断模型构建

张权; 陈建; 刘宝; 高志奇; 赵文琦; 张二龙; 徐刚; 陈德伟; 高钰琪

doi:10.16016/j.2097-0927.202407006

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移居高原男性青年慢性高山病的诊断模型构建

专题报道 | 更新时间：2025-01-10

- 移居高原男性青年慢性高山病的诊断模型构建
- Construction of a diagnostic model for chronic mountain sickness among young male migrants to high-altitude areas
- 陆军军医大学学报 2025年47卷第1期页码：10-19
- 作者机构：
  
  1.陆军军医大学（第三军医大学）高原军事医学系：，高原特需药品与器材研究室，重庆
  2.陆军军医大学（第三军医大学）高原军事医学系：，高原生理学与病理学教研室，重庆
- 作者简介：
  
  高钰琪，E-mail： gaoyq@tmmu.edu.cn
- 基金信息：
  
  重庆英才-重庆市自然科学基金重点项目(CQYC20200101163)
- DOI：10.16016/j.2097-0927.202407006
  中图分类号： R195.4;R446.112;R594.3
- 纸质出版日期：2025-01-15，
  
  收稿日期：2024-07-01，
  
  修回日期：2024-08-21，
- 稿件说明：
移动端阅览
张权,陈建,刘宝,等.移居高原男性青年慢性高山病的诊断模型构建[J].陆军军医大学学报,2025,47(01):10-19.

ZHANG Quan,CHEN Jian,LIU Bao,et al.Construction of a diagnostic model for chronic mountain sickness among young male migrants to high-altitude areas[J].J Army Med Univ,2025,47(1):10-19.
张权,陈建,刘宝,等.移居高原男性青年慢性高山病的诊断模型构建[J].陆军军医大学学报,2025,47(01):10-19. DOI：10.16016/j.2097-0927.202407006.

ZHANG Quan,CHEN Jian,LIU Bao,et al.Construction of a diagnostic model for chronic mountain sickness among young male migrants to high-altitude areas[J].J Army Med Univ,2025,47(1):10-19. DOI：10.16016/j.2097-0927.202407006.

摘要

目的

分析移居高原男性青年慢性高山病（chronic mountain sickness，CMS）发生的危险因素，并构建诊断模型及评估诊断效能。

方法

本研究采用横断面研究设计方案，于2023年6月10日至12月29日以方便抽样方法选取移居到高原（海拔4 500~5 000 m地区）半年及以上的男性青年作为被试者，收集其人口学资料并采集血液样本进行实验室检测。以“慢性高山病青海标准”将被试者分为CMS组和非CMS组。按照8∶2的比例随机抽样将被试者分为训练集和测试集。通过随机森林变量重要性排序、单因素和多因素Logistic回归分析，筛选出CMS发生的独立危险因素并构建诊断模型；采用受试者工作特征曲线、校准曲线、临床决策曲线和影响曲线分析，全面评估模型的诊断效能。

结果

376名抽样被试者经纳入排除后，共308人纳入数据分析，其中CMS患病率为17.53%。呼吸困难或心悸（79.63%）和睡眠障碍（85.19%）是CMS患者的主要临床表现。进一步分析发现，肌酸激酶同工酶MB/肌酸激酶（creatine kinase-MB/creatine kinase，CK-MB/CK，

=2.17，95%

： 1.43~3.28）、高原居住时间（

=2.44，95%

：1.08~5.54）和体质指数（body mass index，BMI，

=1.62，95%

： 1.05~2.50）是CMS发生的三大独立危险因素。训练集和测试集的CMS诊断模型曲线下面积［0.821（95%

： 0.756~0.886）

0.822（95%

： 0.700~0.944）］、特异度（66.30%

73.90%）、敏感度（89.50%

81.20%），提示其区分度较好。通过Hosmer-Lemeshow拟合优度检验评估模型拟合度（

χ²

=10.029，

=0.263）和（

χ²

=4.477，

=0.812），说明模型预测与实际观察结果一致性较好。临床决策曲线分析表明，在阈值概率为0.1~0.7内，模型的净收益优于全干预和无干预策略。临床影响曲线分析显示，当阈值概率

0.4时，模型的预测和实际发病情况高度一致。这2项分析结果共同证实了模型的临床应用价值。

结论

CK-MB/CK、高原居住时间和BMI是CMS的独立危险因素，其构建的诊断模型有助于识别CMS发生潜在个体，进而早期干预以预防CMS对移居高原男性青年生命健康的危害。

Abstract

Objective‍　‍To analyze the risk factors for chronic mountain sickness （CMS） in young male migrants living in high-altitude areas and to construct a diagnostic model and

evaluate its diagnostic efficacy. Methods‍　‍From June 10 to December 29， 2023， a cross-sectional study was conducted on young male migrants subjected with convenience sampling who had been living in high-altitude areas （4 500~5 000 m） for 6 months or longer. Their demographic data were collected and blood samples were collected for laboratory test. According to the Qinghai Score for Chronic Mountain Sickness， they were divided into CMS group and non-CMS group. Then the participants were randomly divided into a training set and a test set in a ratio of 8∶2. Independent risk factors for CMS occurrence were screened out， through random forest variable importance ranking， univariate and multivariable logistic regression analysis， and a diagnostic model was constructed based on these factors. Receiver operating characteristic （ROC） curve analysis， calibration curve analysis， clinical decision curve analysis， and influence curve analysis were used to comprehensively evaluate the diagnostic performance of the model. Results‍　‍According to the inclusion and exclusion criteria， 308 out of 376 participants were finally subjected， and 17.53% of them were diagnosed with CMS. The major clinical symptoms of the CMS patients were dyspnea or palpitations （79.63%） and sleep disorders （85.19%）. Further analysis revealed that creatine kinase-MB/creatine kinase （CK-MB/CK，

=2.17， 95%

： 1.43~3.28）， high-altitude residence time （

=2.44， 95%

： 1.08~5.54）， and body mass index （BMI，

=1.62， 95%

： 1.05~2.50） were 3 major independent risk factors for CMS. The area under the curve （AUC） value of the CMS diagnostic model in the training set and test set was 0.821 （95%

： 0.756~0.886） and 0.821 （95%

： 0.700~0.944）， the specificity was 66.30% and 73.90%， the sensitivity was 89.50% and 81.20%， respectively， indicating good discrimination ability. Hosmer-Lemeshow goodness-of-fit test showed consistency b

etween predicted results and actual observations （

χ²

=10.029，

=0.263；

χ²

=4.477，

=0.812）. Clinical decision curve analysis demonstrated that within the threshold probability range from 0.1 to 0.7， the net benefit of the model exceeded both full intervention and no intervention strategies. The influence curve analysis showed high consistency between the model predictions and actual incidence when the threshold probability exceeded 0.4. These two analyses together confirmed the clinical application value of the model. Conclusion‍　‍CK-MB/CK， high-altitude residence time and BMI are independent risk factors for CMS， and their diagnostic model helps identify potential individuals at risk for CMS. Early intervention can prevent the harm of CMS to the health of young men migrating to high-altitude areas.

关键词

移居高原高原病慢性高山病诊断男性青年

Keywords

migration to high-altitude areasaltitude illnesschronic mountain sicknessdiagnosisyoung male

references

LEON-VELARDE F， MAGGIORINI M， REEVES J T， et al. Consensus statement on chronic and subacute high altitude diseases［J］. High Alt Med Biol， 2005， 6（2）： 147-157. DOI： 10.1089/ham.2005.6.147http://dx.doi.org/10.1089/ham.2005.6.147.

VILLAFUERTE F C， CORANTE N. Chronic mountain sickness： clinical aspects， etiology， management， and treatment［J］. High Alt Med Biol， 2016， 17（2）： 61-69. DOI： 10.1089/ham.2016.0031http://dx.doi.org/10.1089/ham.2016.0031.

李潇潇. 中国军队高原病人群水平影响因素分析及卫勤保障对策研究［D］. 重庆：第三军医大学， 2012.

LI X X. Analysis of influencing factors on the level of plateau patients in China army and research on medical support countermeasures［D］.Chongqing： Third Military Medical University， 2012.

GARRIDO E， BOTELLA DE MAGLIA J， CASTILLO O. Acute， subacute and chronic mountain sickness［J］. Rev Clin Esp， 2021， 221（8）： 481-490. DOI： 10.1016/j.rceng.2019. 12.009http://dx.doi.org/10.1016/j.rceng.2019.12.009.

JIANG C H， CHEN J， LIU F Y， et al. Chronic mountain sickness in Chinese Han males who migrated to the Qinghai-Tibetan Plateau： application and evaluation of diagnostic criteria for chronic mountain sickness［J］. BMC Public Health， 2014， 14： 701. DOI： 10.1186/1471-2458-14-701http://dx.doi.org/10.1186/1471-2458-14-701.

马轶，罗伟. 慢性高原病的最新治疗研究进展［J］. 中西医结合心血管病电子杂志， 2020， 8（35）： 26， 46. DOI： 10.16282/j.cnki.cn11-9336/r.2020.35.016http://dx.doi.org/10.16282/j.cnki.cn11-9336/r.2020.35.016.

MA Y， LUO W. The latest treatment research progress of chronic altitude sickness［J］. Cardiovasc Dis Electron J Integr Tradit Chin West Med， 2020， 8（35）： 26， 46. DOI： 10.16282/j.cnki.cn11-9336/r.2020.35.016http://dx.doi.org/10.16282/j.cnki.cn11-9336/r.2020.35.016.

崔建华，张西洲，王宏运，等. 慢性高原病肝功能及血清酶的改变［J］. 临床军医杂志， 2006， 34（6）： 677-678. DOI： 10.3969/j.issn.1671-3826.2006.06.006http://dx.doi.org/10.3969/j.issn.1671-3826.2006.06.006.

CUI J H， ZHANG X Z， WANG H Y， et al. Liver function and serum enzyme changes of chronic mountain sickness［J］. Clin J Med Off， 2006， 34（6）： 677-678. DOI： 10.3969/j.issn.1671-3826.2006.06.006http://dx.doi.org/10.3969/j.issn.1671-3826.2006.06.006.

MANGALESH S， DUDANI S. Neutrophil-to-lymphocyte ratio for the prediction of the presence and severity of coronary artery disease［J］. Angiology， 2022， 73（10）： 985-986. DOI： 10.1177/00033197221087783http://dx.doi.org/10.1177/00033197221087783.

高钰琪，黄缄. 炎症反应与高原病［J］. 第三军医大学学报， 2016， 38（3）： 215-219. DOI： 10.16016/j.1000-5404.201512076http://dx.doi.org/10.16016/j.1000-5404.201512076.

GAO Y Q， HUANG J. Inflammation and high altitude diseases［J］. J Third Mil Med Univ， 2016， 38（3）： 215-219. DOI： 10.16016/j.1000-5404.201512076http://dx.doi.org/10.16016/j.1000-5404.201512076.

高志奇，谢慎威，何文娟，等. 慢性高原病与血常规和血生化指标的相关性研究［J］. 临床血液学杂志， 2023， 36（8）： 548-552. DOI： 10.13201/j.issn.1004-2806.2023.08.004http://dx.doi.org/10.13201/j.issn.1004-2806.2023.08.004.

GAO Z Q， XIE S W， HE W J， et al. Study on correlation between chronic mountain sickness and blood routine and blood biochemical indexes［J］. J Clin Hematol， 2023， 36（8）： 548-552. DOI： 10.13201/j.issn.1004-2806.2023.08.004http://dx.doi.org/10.13201/j.issn.1004-2806.2023.08.004.

高亮，闫勇力，李彬，等. 塔吉克族高原人群高尿酸血症与慢性高原病关系的探讨［J］. 中国应用生理学杂志， 2017， 33（6）： 554-557. DOI： 10.12047/j.cjap.5557.2017.131http://dx.doi.org/10.12047/j.cjap.5557.2017.131.

GAO L， YAN Y L， LI B， et al. Discussion on the relationship between hyperuricemia and chronic altitude sickness in Tajik plateau population［J］. Chin J Appl Physiol， 2017， 33（6）： 554-557. DOI： 10.12047/j.cjap.5557.2017.131http://dx.doi.org/10.12047/j.cjap.5557.2017.131.

PEI T， LI X X， TAO F S， et al. Burden of disease resulting from chronic mountain sickness among young Chinese male immigrants in Tibet［J］. BMC Public Health， 2012， 12： 401. DOI： 10.1186/1471-2458-12-401http://dx.doi.org/10.1186/1471-2458-12-401.

CHEN Y H， TANG X Q， ZENG X， et al. Gastrointestinal syndrome encountered during a train voyage to high altitudes： a 14-day survey of 69 passengers in China［J］. Travel Med Infect Dis， 2024， 59： 102718. DOI： 10.1016/j.tmaid.2024.102718http://dx.doi.org/10.1016/j.tmaid.2024.102718.

NEGI P C， ASOTRA S， V R K， et al. Epidemiological study of chronic mountain sickness in natives of Spiti Valley in the Greater Himalayas［J］. High Alt Med Biol， 2013， 14（3）： 220-229. DOI： 10.1089/ham.2012.1127http://dx.doi.org/10.1089/ham.2012.1127.

SAN MARTIN R， BRITO J， SIQUES P， et al. Obesity as a conditioning factor for high-altitude diseases［J］. Obes Facts， 2017， 10（4）： 363-372. DOI： 10.1159/000477461http://dx.doi.org/10.1159/000477461.

PATRICIAN A， ANHOLM J D， AINSLIE P N. A narrative review of periodic breathing during sleep at high altitude： from acclimatizing lowlanders to adapted highlanders［J］. J Physiol， 2024， 602（21）： 5435-5448. DOI： 10.1113/JP285427http://dx.doi.org/10.1113/JP285427.

LIU Y， TANG X L， NI Y， et al. Diagnostic value of the creatine kinase-MB/creatine kinase and neutrophil/lymphocyte ratios in acute myocardial infarction［J］. J Cardiothorac Surg， 2024， 19（1）： 227. DOI： 10.1186/s13019-024-02740-9http://dx.doi.org/10.1186/s13019-024-02740-9.

RICHALET J P， HERMAND E， LHUISSIER F J. Cardiovascular physiology and pathophysiology at high altitude［J］. Nat Rev Cardiol， 2024， 21（2）： 75-88. DOI： 10.1038/s41569-023-00924-9http://dx.doi.org/10.1038/s41569-023-00924-9.

LUCAS A， AO-IEONG E S Y， WILLIAMS A T， et al. Increased hemoglobin oxygen affinity with 5-hydroxymethylfurfural supports cardiac function during severe hypoxia［J］. Front Physiol， 2019， 10： 1350. DOI： 10.3389/fphys.2019.01350http://dx.doi.org/10.3389/fphys.2019.01350.

NAEIJE R. Physiological adaptation of the cardiovascular system to high altitude［J］. Prog Cardiovasc Dis， 2010， 52（6）： 456-466. DOI： 10.1016/j.pcad.2010.03.004http://dx.doi.org/10.1016/j.pcad.2010.03.004.

HE S Y， HE S D， YANG Y X， et al. Correlation between neutrophil to lymphocyte ratio and myocardial injury in population exposed to high altitude［J］. Front Cardiovasc Med， 2021， 8： 738817. DOI： 10.3389/fcvm.2021.738817http://dx.doi.org/10.3389/fcvm.2021.738817.

DOUTRELEAU S， ULLIEL-ROCHE M， HANCCO I， et al. Cardiac remodelling in the highest city in the world： effects of altitude and chronic mountain sickness［J］. Eur J Prev Cardiol， 2022， 29（17）： 2154-2162. DOI： 10.1093/eurjpc/zwac166http://dx.doi.org/10.1093/eurjpc/zwac166.

YUAN Z M， ZOU Y W， LIU X X， et al. Longitudinal study on blood and biochemical indexes of Tibetan and Han in high altitude area［J］. Front Public Health， 2023， 11： 1282051. DOI： 10.3389/fpubh.2023.1282051http://dx.doi.org/10.3389/fpubh.2023.1282051.

CARETTI A， BIANCIARDI P， MARINI M， et al. Supplementation of creatine and ribose prevents apoptosis and right ventricle hypertrophy in hypoxic hearts［J］. Curr Pharm Des， 2013， 19（39）： 6873-6879. DOI： 10.2174/138161281939131127114218http://dx.doi.org/10.2174/138161281939131127114218.

ZERVOU S， WHITTINGTON H J， OSTROWSKI P J， et al. Increasing creatine kinase activity protects against hypoxia/reoxygenation injury but not against anthracycline toxicity in vitro［J］. PLoS One， 2017， 12（8）： e0182994. DOI： 10.1371/journal.pone.0182994http://dx.doi.org/10.1371/journal.pone.0182994.

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