Acute high-altitude exposure reduces lung diffusion: Data from the HIGHCARE Alps project

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• 作者：Piergiuseppe Agostoni ; Erik R. Swenson ; Roberto Fumagalli ; Elisabetta Salvioni ; Gaia Cattadori ; Stefania Farina ; Maurizio Bussotti ; Margherita Tamplenizza ; Carolina Lombardi ; Daniele Bonacina ; Maura Brioschi ; Sergio Caravita ; Pietro Modesti ; Miriam Revera ; Andrea Giuliano ; Paolo Meriggi ; Andrea Faini ; Grzegorz Bilo ; Cristina Banfi ; Gianfranco Parati ; et al.
• 关键词：Gas exchange ; Surfactant derived proteins ; Pulmonary edema ; Hypoxia
• 刊名：Respiratory Physiology & Neurobiology
• 出版年：2013
• 出版时间：15 August, 2013
• 年：2013
• 卷：188
• 期：2
• 页码：223-228
• 全文大小：670 K

文摘

The causes and development of lung fluid, as well as the integrity of the alveolar-capillary membrane at high altitude, are undefined. This study was conceived to see whether fluid accumulates within the lung with acute high altitude exposure, and whether this is associated with alveolar capillary membrane damage. We studied lung carbon monoxide diffusion (DL_CO), its components - membrane diffusion (D_M) and capillary volume (V_C) and alveolar volume (V_A) measured in 43 healthy subjects in Milan (122 m) and after 1 and 3 days at Capanna Regina Margherita (4559 m). DL_CO measurement was adjusted for hemoglobin and inspired oxygen. We also measured plasma surfactant derived protein B (SPB) and Receptor of Advanced Glycation End-products (RAGE) as markers of alveolar-capillary membrane damage, and ultrasound lung comets as a marker of extravascular lung water. 21 subjects received acetazolamide and 22 placebo.

DL_CO was lower at Capanna Regina Margherita (day 1: 24.3 ¡À 4.7 and day 3: 23.6 ¡À 5.4 mL/mmHg/min), than in Milan (25.8 ¡À 5.5; p < 0.001 vs. day 1 and 3) due to D_M reduction (Milan: 50.5 ¡À 14.6 mL/mmHg/min, Capanna Regina Margherita day 1: 45.1 ¡À 11.5 mL/mmHg/min, day 3: 43.2 ¡À 13.9 mL/mmHg/min; p < 0.05 Milan vs. day 3) with a partially compensatory V_C increase (Milan: 96 ¡À 37 mL, Capanna Regina Margherita day 1: 152 ¡À 66 mL, day 3: 153 ¡À 59 mL; p < 0.001 Milan vs. day 1 and day 3). Acetazolamide did not prevent the fall in DL_CO albeit, between day 1 and 3, such a trend was observed. Regardless of treatment lung comets increased from 0 to 7.2 ¡À 3.6 (p < 0.0001). SPB and RAGE were unchanged. Lung fluid increased at high altitude without evidence from plasma measurements, supporting alveolar-capillary damage.