摘要目的 初步探讨西藏高海拔因素对人胃黏膜大体形态、组织结构的影响及其机制.方法 随机选择平均海拔为4500米的西藏山南地区错那镇患有慢性高原病(CMS)的世居藏族居民25例为研究组;选择平均海拔2000米以下的西藏山南地区勒布镇健康世居藏族居民25例为对照组,两组均行胃镜检查和胃黏膜活检,观察胃黏膜内镜下表现、组织病理学改变及组织超微结构特点;同时用免疫组化法检测胃黏膜组织中缺氧诱导因子1α(HIF-1α)表达.结果 研究组中,胃黏膜色泽较对照组而言呈暗红、深红;慢性胃体炎和胃溃疡的检出率在两组间差异有统计学意义(26.7%、6.1%比3.3%、0%,P<0.05),幽门收缩情况差异有统计学意义(33%比70%,P<0.05).研究组与对照组比较,非萎缩性胃体炎和慢性萎缩性胃窦炎检出率差异均有统计学意义(P<0.05).透射电镜观察发现,研究组胃黏膜上皮细胞受损.CMS患者胃黏膜组织中HIF-1α表达明显增高(102.9±34.04比14.04±6.53,P<0.05).结论 高海拔因素可能与胃黏膜损伤有关,CMS患者胃黏膜组织中HIF-1α基因的上调是高原胃黏膜病变的可能机制.

abstractsObjective To investigate the impact of high altitude on human gastric mucosa and its underlying mechanisms. Methods Twenty-five native Tibetans with chronic mountain sickness CMS residing at high altitude (4500 m) were examined for ultrastrueture and pathological changes of gastric mucosa. The other 25 native Tibetans residing at low altitude (＜2000 m) were served as control.The expression of hypoxia-inducible factor (HIF)-1α in human gastric mucosa was detected with immunohistochemistry. Results The color of gastric mucosa presented dark in patients with CMS.The histopathological examination showed significant differecnce in incidence of cnronc body gastritis and atrophic gastritis between CMS group and control group (P＜0. 05). The transmission electronic microscopy revealed that the epithlieal cells of gastric mucosa were impared in CMS group compared to control group. The expression of HIF-1α protein was increased in CMS group in comparison of control group (102.94± 34.04 vs 14.04 ± 6.53, P＜0.05). Conclusions The high altitude may involve in damage of gastric mucosa and the up-regulation of HIF-1α protein may involve in its mechanism.