| As we all known, due to changes in oxygen environment, people of long lived in the plain areas arriving at the plateau area will appear plateau reaction such as plateau pulmonary edema and cerebral edema, some mild cases will emerge cyanosis, dizziness,fatigue, dyspnea, myasthenia of limbs, and other symptoms. Severe cases appear headache,nausea and vomiting, palpitation and even coma. However, People of native plateau or people who have long lived in the plateau region after arriving at the plain will also produces a series of compensatory adaptive changes, appear "De-acclimatization Symptoms" such as tiredness, weakness, drowsiness, dizziness, palpitations, chest tightness, shortness of breath, lack of appetite and sleep disorders, defined as “high altitude de-acclimatization reaction(HADR)”.At present, the research on HADR is still in infancy. Recently researches focused on the description of the symptoms or the incidence of HADR, however, the mechanism of pathological physiology changes in each system, the change rules, the influence of human body and prevention measures are still in mystery. This study first analyzed the healthy native plateau physical examination and the hematology analysis of plateau patients with cerebral tumor; to explore the potential impacts of hematology related indicators on surgery of plateau people in plains, which have a great significance for effectively prevent and reduce the risk of surgery to plateau patients in the plains and post-operative complications. Through establish the animal models of high altitude hypobaric and hypoxia, conduct a comprehensive and system study on the variation of hematology and central nervous system(CNS) related changes in de-acclimatization period, such as the blood brain barrier(BBB) permeability, vascular endothelial growth factor(VEGF),cerebral microvascular density(BMVD) and hypoxia-inducible factor(HIF). Intention to provide some scientific basis for the pathogenesis, prediction and prevention of HADR and maintenance health of plateau people returned to the plains. Based on this, the paper will discuss from the following five parts.1. The changes and significance of hematology and ECG in natives plateau after moved to the plainsThe experiment screening patients in Xi Jing hospital who have lived long in Tibet Ali area(average elevation of 4500 m) in November 2012 as the research object, examine their hematology and electrocardiogram after their second day arrival in the plains, and choose local patients(average elevation of 400 m) in Xi Jing hospital medical center for the control group, which possess substantially the same factors including age, sex ratio and the nature of work. Results showed that the population plateau red blood cell(RBC),hemoglobin(HGB), hematocrit(HCT) and fibrinogen(FIB) are significantly higher than the control group(P<0.05), but platelets(PLT) and heart rate(HR) are significantly lower than the control group(P <0.05). The results suggested that hematology indicators such as PLT, FIB and HR significantly changes, which could be used as monitor indicators in high altitude de-acclimatization period.2. The potential impacts of hematological changes on the operation of the Native Plateau brain tumor patients in the plainsUnder strict inclusion criteria, We selected 45 patients with cerebral tumor in our department from the Qinghai plateau region(an average elevation of 3245 m), and selected 45 patients with cerebral tumor from local(average altitude 400 m) as the control group, To investigate influence of hematology changes to the surgical safety of native plateau brain tumor patients in the plains. The results showed that the RBC, HBG, HCT levels of the plateau group were obviously increased in pre-operation(P < 0.05), PLT was significantly reduced(P < 0.05). Plateau group RBC, HBG, HCT levels were declined at the third day post-operation, and PLT level was increased, while the above indexes in the plain group did not change obviously post-operation. The results show that there are still some differences in hematological of Native Plateau brain tumor patients after they arrival plains, which might cause certain influence to the operation such as intraoperative or postoperative bleeding tendency, we should attach great importance to reduce the risk of surgery of native plateau brain tumor patients in the plain.3. The hematology indexes changes and its changing regularity in the rat model of experimentally induced hypobaric and hypoxia to normoxiaIn the early stage of our experiment, we established the plateau hypobaric and hypoxia rat model, further study the changes and variation of hematological indices after return to the plains. The results show that the RBC, HBG, HCT levels are significantly higher than the control group(P<0.05),and gradually decreases with time return to the plains prolonged. The PLT is relatively lower than the control group and the prothrombin time(PT) and the activated partial thromboplastin time(APTT) is shorter(P < 0.05),and gradually increase with time return to the plains prolonged, while still exist some differences with the control group at 30 th day return to the plains. the blood routine test and the coagulation of blood of plateau model group will occur some changes after returned to the plains, but the changes is a restorative process with returned to the plains prolonged.4. The changes of BBB and its significance in the rat model of experimentally induced hypobaric and hypoxia to normoxiaUsing the Evans blue(EB) tracer combined with brain tissue EB quantitative method to detect the blood brain barrier(BBB) permeability of the hypobaric and hypoxia rat model. The results show that brain tissue EB content is significantly higher than the control group, and has significant negative correlation with return to the plains prolonged(r=-0.898,P=0.038). The results prompt that altitude environment has some damage on the blood-brain barrier; some nervous system symptoms of HADR may be associated with BBB damage.5. The changes of HIF-1α, VEGF and BMVD and its significancein in the rat model of experimentally induced hypobaric and hypoxia to normoxia in HADR periodWe tested the expression of BMVD, VEGF and HIF-1α detection by immunohistochemical technique. The results show that BMVD, VEGF and HIF-1α of the model group obviously increased than control group(P<0.05),and BMVD change with HIF-1α and VEGF is obviously correlated. As the extension of time in the plain, the expression of BMVD, VEGF and HIF-1α levels gradually declined and presence significant correlation. The results showed that after returning to plain, BMVD, VEGF and HIF-1α in rat brain tissue of the model group appear a slow recovery trend, the BMVD changes may be related to the low expression level of VEGF and HIF-1α. Therefore, the BMVD, VEGF and HIF-1α could be used as changes monitoring indicators of CNS in plateau de-adaptation period. |
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