Investigation On Influencing Factors Of Erythrocytosis And Its Relationship With Proinflammatory Cytokines

Objective: To investigate the pathogenetic factors ofplateau polycythemia in soldiers served in Tibet for its further preventionand treatment. Methods: The method of sampling study was adopted inthis subject. Samples were from728soldiers served in Shannan, Shigatse,Nagchu areas in Tibet. Through blood samples collecting, questionnairesurvey and portable testing equipment inspection, the data of these menwere collected, including blood, altitude, nationality, native place, height,weight, thoracic volume, age of entering the Tibet, acute mountainreaction, plateau accumulated work time, plateau exercise way, nap time,night sleep time, average daily water intake, daily smoke, smokinghistory, heart rate, systolic pressure, diastolic blood pressure, bloodoxygen saturation, FVC, FEV1, FEV1/FVC, etc. Samples were dividedinto plateau erythrocytosis group and non-plateau erythrocytosis groupaccording to the blood routine analysis results (Hb </≧210g/L) andmade relevant epidemiological statistical analysis. Result:○1Comparedto the group at altitude≤4000m, the plateau erythrocytosis incidence ofgroups at altitude4000m-4500m and＞4500m were markedly higher（26.25%vs5.41%P＜0.001;25.16%vs5.41%P＜0.001the level ofsignificance after correction P’=0.0125）.○2Difference of plateauerythrocytosis incidence between groups composed of soldiers served in army≤2y and2y-5y respectively reached statistical significance (12.78%vs26.03%P＜0.001the level of significance after correction P’=0.0125).○3The body mass index of plateau erythrocytosis group was markedlyhigher than that of non-plateau erythrocytosis group (21.63±2.11vs21.01±2.08P=0.003).○4Binary logistic regression analysis showed thataltitude and accumulation of different altitude hypoxic exposure effectwere the risk factors of plateau erythrocytosis. The soldiers served ataltitude4000m-4500m and＞4500m had7.171-fold and6.178-foldincreased risk of developing plateau erythrocytosis than who served ataltitude≤4000m respectively (95%CI=3.805-13.514P＜0.001;95%CI=3.209-11.895P＜0.001). It also showed that physical exercisewas a risk factor of plateau erythrocytosis and that the soldiers doingother exercise besides military training than only doing military traininghad a0.566-fold decreased risk of developing plateau erythrocytosis(95%CI=0.328-0.976P=0.041). Besides, average daily water intake wasinvolved in the influence factors of plateau erythrocytosis. Conclusions:The plateau erythrocytosis of soldiers served in Tibet is associated withaltitude, hypoxic exposure time, exercise way, average daily water intake,body mass index. The prevention of plateau erythrocytosis of plateausoldiers should be emphasized to exchange defensive between differentaltitude garrisons regularly. Besides, proper physical exercise andindividualized management of water intake could also reduce the happening of the disease. Objective: To analyze the correlation of plateaupolycythemia and pro-inflammatory cytokines (TNF-a、IFN-r、IL-1b、IL-2、IL-6) in soldiers served in Tibet. Methods: To examine the serumlevels of EPO, TNF-a, IFN-r, IL-1b, IL-2and IL-6in the cases (HAPC ofthe Han), controls (non-HAPC of the Han) and Tibetan group(non-HAPC of the Tibetan) through Enzyme Linked ImmunoSorbentAssay (ELISA). Differences between groups compare with t test, andP-value level≤0.05was considered statistically significant. Results:○1Shannan region: Compared with the non-HAPC group and Tibetan group,the level of IFN-γ was markedly lower in the HAPC group. There was nosignificant difference between the non-HAPC group and Tibetan group.○2Shigatse region: The level of IFN-γ was markedly lower in the HAPCgroup than in the non-HAPC group and Tibetan group. There was nosignificant difference shown in the comparison between the non-HAPCgroup and Tibetan group.○3Nagchu region (service time≤5years): Thelevels of EPO、TNF-α and IL-6were markedly lower in the HAPC groupthan that in the non-HAPC group, and the levels of TNF-α and IL-6weremarkedly lower than that in the Tibetan group. None of indexes showedstatistical significance in the comparison between the non-HAPC group and Tibetan group.○4Nagchu region (5years＜service time≤10years):The HAPC group had a significantly lower levels of TNF-α and IFN-γin the compared with the non-HAPC group and Tibetan group. None ofindexes showed significant difference between the non-HAPC group andTibetan group. Conclusion: EPO resistance may be the mechanism forboth the Han and the Tibetan adapting to the high altitude environment.The occurrence of high altitude polycythemia in soldiers served in Tibetmay be related to the Pro-inflammatory cytokines, especially to theIFN-γ.