Sean P Langan, Emily C Tagesen, Steven D Landspurg, Peter S Figueiredo, Quint N Berkemeier, Melissa D McInnis, Robert L Alunday, Aaron J Reilly, Trevor J Mayschak, Erik R Swenson, Pierre A Fabries, Jon K Femling, Beth A Beidleman
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AMS cerebral factor score (AMS-C) was measured daily and peak scores were calculated. Active ascenders had higher energy expenditure (1,265 ± 351 vs. 408 ± 208 kcal) and lower oxygen saturation ([Formula: see text]) (75 ± 3 vs. 82 ± 3%) during ascent. Norepinephrine and lactate were higher (<i>P</i> < 0.007) in active ascenders on HA1. All other data were combined due to lack of group differences. Glucose, insulin, and HOMA-IR were elevated (<i>P</i> < 0.05) on HA2 (105.9 ± 12.3 mg/dL; 12.1 ± 6.8 µIU/mL; 3.2 ± 2.1 au) and HA3 (101.8 ± 11.2 mg/dL; 10.2 ± 5.5 µIU/mL; 2.2 ± 1.4 au) vs. baseline and returned to normal on HA4. Epinephrine (<i>P</i> < 0.001) and cortisol (<i>P</i> = 0.004) were elevated on HA1 and HA2 vs. baseline, respectively. GLP-1 was higher on HA1 vs. HA2 and HA3 (<i>P</i> < 0.021). Glucose (<i>r</i><sub>rm</sub> = 0.42; <i>P</i> = 0.001), insulin (<i>r</i><sub>rm</sub> = 0.29; <i>P</i> = 0.001), HOMA-IR (<i>r</i><sub>rm</sub> = 0.27; <i>P</i> = 0.002), epinephrine (<i>r</i><sub>rm</sub> = 0.34; <i>P</i> < 0.001), and norepinephrine (<i>r</i><sub>rm</sub> = 0.20; <i>P</i> = 0.027) were significantly correlated with AMS-C. Transient perturbations to glucose metabolism during 4 days of HA exposure influences AMS severity without further impact from active ascent.<b>NEW & NOTEWORTHY</b> We demonstrate insulin resistance during 4 days of exposure at 4,300 m is positively correlated with acute mountain sickness (AMS) severity. This builds on previous data showing insulin sensitivity and carbohydrate metabolism at sea-level predict AMS. The blood glucose excursions appear at least partly mediated by cortisol and nocturnal hypoxemia.</p>","PeriodicalId":7630,"journal":{"name":"American journal of physiology. 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Thirty-two unacclimatized soldiers (23 ± 4 yr; 80 ± 14 kg) were tested at baseline residence (BLR), hiked ∼5 km (<i>n</i> = 16) or were driven (<i>n</i> = 16) to 4,300 m, and stayed for 4 days (∼66 h). Venous blood was taken each morning at BLR and during high altitude (HA) exposure <i>days 2</i>-<i>4</i> (HA2-4) and the evening on <i>day 1</i> at HA (HA1). Metabolites and hormones were measured, and insulin resistance (HOMA-IR) was calculated. AMS cerebral factor score (AMS-C) was measured daily and peak scores were calculated. Active ascenders had higher energy expenditure (1,265 ± 351 vs. 408 ± 208 kcal) and lower oxygen saturation ([Formula: see text]) (75 ± 3 vs. 82 ± 3%) during ascent. Norepinephrine and lactate were higher (<i>P</i> < 0.007) in active ascenders on HA1. All other data were combined due to lack of group differences. Glucose, insulin, and HOMA-IR were elevated (<i>P</i> < 0.05) on HA2 (105.9 ± 12.3 mg/dL; 12.1 ± 6.8 µIU/mL; 3.2 ± 2.1 au) and HA3 (101.8 ± 11.2 mg/dL; 10.2 ± 5.5 µIU/mL; 2.2 ± 1.4 au) vs. baseline and returned to normal on HA4. Epinephrine (<i>P</i> < 0.001) and cortisol (<i>P</i> = 0.004) were elevated on HA1 and HA2 vs. baseline, respectively. GLP-1 was higher on HA1 vs. HA2 and HA3 (<i>P</i> < 0.021). Glucose (<i>r</i><sub>rm</sub> = 0.42; <i>P</i> = 0.001), insulin (<i>r</i><sub>rm</sub> = 0.29; <i>P</i> = 0.001), HOMA-IR (<i>r</i><sub>rm</sub> = 0.27; <i>P</i> = 0.002), epinephrine (<i>r</i><sub>rm</sub> = 0.34; <i>P</i> < 0.001), and norepinephrine (<i>r</i><sub>rm</sub> = 0.20; <i>P</i> = 0.027) were significantly correlated with AMS-C. 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引用次数: 0
摘要
胰岛素抵抗与急性高原病（AMS）风险有关，但积极攀登的影响尚不清楚。方法：对32名未适应环境的士兵（23±4岁，80±14 kg）进行基线居住地（BLR）测试，徒步（n=16）或驱车（n=16）至4300 m，停留4 d （~66 h）。每天早上在BLR和高海拔暴露第2-4天（HA2-4）和第1天晚上在高海拔暴露（HA1）时取静脉血。测量代谢产物和激素，计算胰岛素抵抗（HOMA-IR）。每日测定AMS脑因子评分（AMS- c）并计算峰值评分。结果：主动爬坡者在爬坡过程中能量消耗较高（1265±351 kcal vs. 408±208 kcal），血氧饱和度较低（75±3 kcal vs. 82±3%）。去甲肾上腺素和乳酸水平分别高于基线水平（PPPP=0.004）。GLP-1对HA1的影响高于HA2和HA3 (Prm=0.42， P=0.001)，胰岛素（rrm=0.29， P=0.001）、HOMA-IR （rrm=0.27， P=0.002）、肾上腺素（rrm=0.34, Prm=0.20， P=0.027）与AMS-C显著相关。结论：暴露于HA的4天内，葡萄糖代谢的短暂扰动会影响AMS的严重程度，而不受主动上升的进一步影响。
Hypoxia-induced impairments in fasting glucose are associated with acute mountain sickness severity during 4 days of residence at 4,300 m.
Insulin resistance has been associated with acute mountain sickness (AMS) risk, but the influence of active ascent is unclear. Thirty-two unacclimatized soldiers (23 ± 4 yr; 80 ± 14 kg) were tested at baseline residence (BLR), hiked ∼5 km (n = 16) or were driven (n = 16) to 4,300 m, and stayed for 4 days (∼66 h). Venous blood was taken each morning at BLR and during high altitude (HA) exposure days 2-4 (HA2-4) and the evening on day 1 at HA (HA1). Metabolites and hormones were measured, and insulin resistance (HOMA-IR) was calculated. AMS cerebral factor score (AMS-C) was measured daily and peak scores were calculated. Active ascenders had higher energy expenditure (1,265 ± 351 vs. 408 ± 208 kcal) and lower oxygen saturation ([Formula: see text]) (75 ± 3 vs. 82 ± 3%) during ascent. Norepinephrine and lactate were higher (P < 0.007) in active ascenders on HA1. All other data were combined due to lack of group differences. Glucose, insulin, and HOMA-IR were elevated (P < 0.05) on HA2 (105.9 ± 12.3 mg/dL; 12.1 ± 6.8 µIU/mL; 3.2 ± 2.1 au) and HA3 (101.8 ± 11.2 mg/dL; 10.2 ± 5.5 µIU/mL; 2.2 ± 1.4 au) vs. baseline and returned to normal on HA4. Epinephrine (P < 0.001) and cortisol (P = 0.004) were elevated on HA1 and HA2 vs. baseline, respectively. GLP-1 was higher on HA1 vs. HA2 and HA3 (P < 0.021). Glucose (rrm = 0.42; P = 0.001), insulin (rrm = 0.29; P = 0.001), HOMA-IR (rrm = 0.27; P = 0.002), epinephrine (rrm = 0.34; P < 0.001), and norepinephrine (rrm = 0.20; P = 0.027) were significantly correlated with AMS-C. Transient perturbations to glucose metabolism during 4 days of HA exposure influences AMS severity without further impact from active ascent.NEW & NOTEWORTHY We demonstrate insulin resistance during 4 days of exposure at 4,300 m is positively correlated with acute mountain sickness (AMS) severity. This builds on previous data showing insulin sensitivity and carbohydrate metabolism at sea-level predict AMS. The blood glucose excursions appear at least partly mediated by cortisol and nocturnal hypoxemia.
期刊介绍：
The American Journal of Physiology-Regulatory, Integrative and Comparative Physiology publishes original investigations that illuminate normal or abnormal regulation and integration of physiological mechanisms at all levels of biological organization, ranging from molecules to humans, including clinical investigations. Major areas of emphasis include regulation in genetically modified animals; model organisms; development and tissue plasticity; neurohumoral control of circulation and hypertension; local control of circulation; cardiac and renal integration; thirst and volume, electrolyte homeostasis; glucose homeostasis and energy balance; appetite and obesity; inflammation and cytokines; integrative physiology of pregnancy-parturition-lactation; and thermoregulation and adaptations to exercise and environmental stress.
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