不同海拔地区藏、汉族健康人脑血管反应性研究
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摘要
目的探讨高海拔藏汉族及不同海拔汉族健康成年人脑血管反应性(cerebrovascular reactivity,CVR)的差异,以及血浆一氧化氮(nitric oxide,NO)和内皮型一氧化氮合酶(endothelial NOS,eNOS)对脑血管反应性可能的调节作用。方法选取世居青海果洛(海拔3800 m)健康藏族45人为高海拔藏族组;在当地生活10 y以上的健康汉族45人为高海拔汉族组;世居青海西宁(海拔2200米)健康汉族45人为中海拔汉族组;世居四川广汉(海拔450米)健康汉族45人为低海拔汉族组。采用经颅多普勒超声(Transcranial Doppler,TCD)评估研究人群CVR,用硝酸还原酶法和酶联免疫吸附法测定各组血浆NO和e NOS水平。结果 (1)世居高海拔藏族组CVR、血浆NO及eNOS含量与高海拔汉族组无显著差异(P>0.05);(2)低海拔汉族组CVR、血浆NO及eNOS含量明显高于中海拔汉族组(P<0.05);(3)中海拔汉族组CVR、血浆NO及eNOS含量明显高于高海拔汉族组(P<0.05);(4)低海拔汉族组CVR、血浆NO及eNOS含量明显高于高海拔汉族组(P<0.05);(5)随着海拔高度越高,汉族健康人CVR、血浆NO及eNOS含量也越下降(P<0.05)。结论高海拔地区藏汉族之间脑血管反应性没有明显差异;不同海拔汉族健康人群之间脑血管反应性有明显差异,且随着海拔高度逐渐升高,脑血管反应性逐渐下降,血浆一氧化氮和内皮型一氧化氮合酶与脑血管反应性可能有一定相关性。
Objective To investigate the differences of cerebral vascular reactivity between Han nationality and Han nationality in healthy adults at high altitude,and the possible regulatory effect of plasma nitric oxide and synthase on cerebrovascular reactivity. Methods Selected 45 people from Qinghai Guoluo( 3800 meters above sea level) as the group of localized high altitude Tibetans,selected 45 Han Chinese subjects who lived in high altitude more then 10 years as the group of the Han Chinese who moved from low altitude,45 Han Chinese subjects who lived in moderate altitude in Xining( 2200m) as the group of the cerebrovascular reactivity in moderate altitude Han Chinese,45 Han Chinese subjects from Sichuan Guanghan( 450 m) as the group of low altitude Han Chinese. Transcranial Doppler ultrasound was recruited to assess cerebrovascular reactivity( CVR). The nitrate reduction method and enzyme linked immunosorbent( ELISA) method were recruited to determine the levels of plasma NO and plasma e NOS. Results( 1) Localized high altitude Tibetans' cerebrovascular reactivity,plasma NO,plasma e NOS had little difference with the Han Chinese who moved from low altitude( P >0. 05).( 2) The cerebrovascular reactivity in low altitude Han Chinese,plasma NO,plasma e NOS were significantly higher than the Han Chinese subjects from moderate elevation( P < 0. 05).( 3) The cerebrovascular reactivity in moderate altitude Han Chinese subjects,plasma NO and plasma e NOS were significantly higher than that of the high altitude Han Chinese subjects( P < 0. 05).( 4) The cerebrovascular reactivity,plasma NO and plasma e NOS in low altitude Han Chinese were significantly higher than that of the high altitude Han Chinese group( P < 0. 05).( 5) The higher the altitude,the Han people's cerebrovascular reactivity was lower,the plasma NO and plasma e NOS were lower( P < 0. 05). Conclusion Cerebrovascular reactivity,the plasma NO and plasma e NOS among high altitude Tibetans have no difference with the Han people.Cerebrovascular reactivity have obvious difference between different altitude in Chinese Han population,and as the altitude gradually increased,cerebrovascular reactivity decreased gradually,plasma NO and plasma e NOS and cerebrovascular reactivity may have a certain relevance.
Objective To investigate the differences of cerebral vascular reactivity between Han nationality and Han nationality in healthy adults at high altitude,and the possible regulatory effect of plasma nitric oxide and synthase on cerebrovascular reactivity. Methods Selected 45 people from Qinghai Guoluo( 3800 meters above sea level) as the group of localized high altitude Tibetans,selected 45 Han Chinese subjects who lived in high altitude more then 10 years as the group of the Han Chinese who moved from low altitude,45 Han Chinese subjects who lived in moderate altitude in Xining( 2200m) as the group of the cerebrovascular reactivity in moderate altitude Han Chinese,45 Han Chinese subjects from Sichuan Guanghan( 450 m) as the group of low altitude Han Chinese. Transcranial Doppler ultrasound was recruited to assess cerebrovascular reactivity( CVR). The nitrate reduction method and enzyme linked immunosorbent( ELISA) method were recruited to determine the levels of plasma NO and plasma e NOS. Results( 1) Localized high altitude Tibetans' cerebrovascular reactivity,plasma NO,plasma e NOS had little difference with the Han Chinese who moved from low altitude( P >0. 05).( 2) The cerebrovascular reactivity in low altitude Han Chinese,plasma NO,plasma e NOS were significantly higher than the Han Chinese subjects from moderate elevation( P < 0. 05).( 3) The cerebrovascular reactivity in moderate altitude Han Chinese subjects,plasma NO and plasma e NOS were significantly higher than that of the high altitude Han Chinese subjects( P < 0. 05).( 4) The cerebrovascular reactivity,plasma NO and plasma e NOS in low altitude Han Chinese were significantly higher than that of the high altitude Han Chinese group( P < 0. 05).( 5) The higher the altitude,the Han people's cerebrovascular reactivity was lower,the plasma NO and plasma e NOS were lower( P < 0. 05). Conclusion Cerebrovascular reactivity,the plasma NO and plasma e NOS among high altitude Tibetans have no difference with the Han people.Cerebrovascular reactivity have obvious difference between different altitude in Chinese Han population,and as the altitude gradually increased,cerebrovascular reactivity decreased gradually,plasma NO and plasma e NOS and cerebrovascular reactivity may have a certain relevance.
引文
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[6]温子龙,刘佳,曾国禄,等.柴胡加龙骨牡蛎汤配合颈椎牵引治疗颈性眩晕20例的TCD观察[J].中国现代医学杂志,2012,22(30):110-112.
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[10]金肆.急性低氧时Wistar大鼠与高原鼠兔肺组织内皮型一氧化氮合酶基因表达的变化[J].中国组织化学与细胞化学杂志,2005,14(5):572-576.
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[12]郑必海,李素芝,周小波,等.外源性NO对快速进入高原现场幼猪氧代谢动力学的影响[J].中国医师杂志,2005,7(7):924-925.
[13]Pretnar-Oblak J,Zaletel M,Zvan B,et al.Cerebrovascular reactivity to L-arginine in partients with lacunar infarctions[J].Cerebrovasc Dis,2005,21(3):180-186.
[14]薛婧,徐江涛,宋永斌,等.高原脑血管病的研究进展[J].现代生物医学进展,2009,9(21):4199-4201.
[15]Yang F,Shi W,Shi J,et al.Assessment of cerebrovascular reserve in unilateral middle cerebral artery stenosis using perfusion CT and CO2 inhalation tests[J].Int J Neurosci,2016,13:1-18.
[16]周锦.e NOS基因转染对慢性缺氧性肺动脉高压的影响[N].第四军医大学学报,2006,18:1671-1674.
[17]Jin HG.Hypoxia-induced up regulation of endo the 2 lial small G protein Rho A and Rho-kinase/ROCK2 inhibits e NOS expression[J].Neurosci Lett,2006,408(1):62-67.
[18]Wu S,Hao G,Zhang S,et al.Cerebral vasoconstriction reactions and plasma levels of ETBR,ET-1,and e NOS in patients with chronic high altitude disease[J].Mol Med Rep,2016,14(3):2497-2502.
[2]Gur AY,Bova I,Nornstein NM.Is impaired cerebral vasomotor reactivity a predictive factor of stroke in asymptomatic patients[J].Stroke,1996,27:2188-2190.
[3]Markus H,Cullinanne M.Severely impaired cecebrovascular reactivity predicts stroke and TIA risk in patients with carotid artery stenosis and occlusion[J].Brain,2001,124:457-467.
[4]徐运.脑血管储备功能与缺血性卒中[J].中国卒中杂志,2007,2:652-654.
[5]Toda N.Phylogenesis of constitutively formed nitric oxide in nonmammals[J].Rey Physiol Biochem Pharmacol,2006,157:31-80.
[6]温子龙,刘佳,曾国禄,等.柴胡加龙骨牡蛎汤配合颈椎牵引治疗颈性眩晕20例的TCD观察[J].中国现代医学杂志,2012,22(30):110-112.
[7]彭忠兴,黄旭明,洪铭范,等.血浆一氧化氮水平和脑血管反应性与进展性卒中的关系研究[J].脑与神经疾病,2010,18(4):244-247.
[8]Naylor ARA,Merrick MVM,Gillespie II,et al.Prevalence of impaired cerebrovascular reserve in patients with symptomatic carotid artery disease[J].British J Surgery,1993,81(1):45-48.
[9]Cynthia M,Beal I,Daniel L,et al.Erzurum.Nitric oxide in adaptation to altitude[J].Free Radical Biol Med,2012,52(7):1123-1134.
[10]金肆.急性低氧时Wistar大鼠与高原鼠兔肺组织内皮型一氧化氮合酶基因表达的变化[J].中国组织化学与细胞化学杂志,2005,14(5):572-576.
[11]高庆春.经颅多普勒超声在脑血管储备功能评价中的应用[J].中国卒中杂志,2008,3:39-44.
[12]郑必海,李素芝,周小波,等.外源性NO对快速进入高原现场幼猪氧代谢动力学的影响[J].中国医师杂志,2005,7(7):924-925.
[13]Pretnar-Oblak J,Zaletel M,Zvan B,et al.Cerebrovascular reactivity to L-arginine in partients with lacunar infarctions[J].Cerebrovasc Dis,2005,21(3):180-186.
[14]薛婧,徐江涛,宋永斌,等.高原脑血管病的研究进展[J].现代生物医学进展,2009,9(21):4199-4201.
[15]Yang F,Shi W,Shi J,et al.Assessment of cerebrovascular reserve in unilateral middle cerebral artery stenosis using perfusion CT and CO2 inhalation tests[J].Int J Neurosci,2016,13:1-18.
[16]周锦.e NOS基因转染对慢性缺氧性肺动脉高压的影响[N].第四军医大学学报,2006,18:1671-1674.
[17]Jin HG.Hypoxia-induced up regulation of endo the 2 lial small G protein Rho A and Rho-kinase/ROCK2 inhibits e NOS expression[J].Neurosci Lett,2006,408(1):62-67.
[18]Wu S,Hao G,Zhang S,et al.Cerebral vasoconstriction reactions and plasma levels of ETBR,ET-1,and e NOS in patients with chronic high altitude disease[J].Mol Med Rep,2016,14(3):2497-2502.