短期高海拔暴露对世居海平面青年脉络膜循环的影响

Effects of short-term high-altitude exposure on choroidal circulation in young adult sea-level residents

摘要

目的 探讨短期高海拔暴露对世居海平面健康成年人脉络膜血流的影响。方法 共纳入 9 名世居于海平面的青年健康志愿者，分别于基线海平面，高海拔暴露第2、4、7、10 天以及返回海平面后的第3、5、9 天采用光学相干断层血管成像收集 8 次数据，采集各时间点的双眼脉络膜厚度、脉络膜基质体积、脉络膜血管体积、脉络膜血管指数和脉络膜毛细血管血流密度进行定量分析。统计分析采用线性混合效应模型。结果 脉络膜基质体积在高海拔暴露第 2 天显著升高（P<0.05），并在第 10 天达到峰值，返回海平面后第 3 天下降，与基线无明显差异；脉络膜血管体积和脉络膜血管指数从暴露第 2 天起显著下降（P<0.05），在第 4,7,10 天与暴露第 2 天无差异，在返回海平面后第 3 天回升至基线水平（P>0.05）；脉络膜毛细血管血流密度仅在暴露第4天出现一过性显著上升（P<0.05），其余时间点与基线相比无明显差异；脉络膜平均厚度在暴露前、中、后未出现明显变化。结论 短期高海拔暴露会引起世居于海平面的健康成年人的脉络膜血流变化，脱离高海拔环境可恢复。

Abstract

Objective To investigate the effects of short-term high-altitude exposure on choroidal blood flow in healthy adults residing at sea level．Methods This prospective observational study included 9 healthy sea level-residing volunteers．Optical coherence tomography angiography was performed at eight time points： baseline at sea level，on days 2，4，7，and 10 of high-altitude exposure，and on days 3，5，and 9 after returning to sea level．Bilateral choroidal parameters，including choroidal thickness，choroidal stromal volume，choroi- dal vascular volume，choroidal vascularity index，and choriocapillaris flow density，were quantitatively ana- lyzed．Linear mixed-effects models were employed for statistical analysis．Results Choroidal stromal volume was significantly elevated on day 2 of high-altitude exposure（P<0.05），peaked on day 10，and decreased by day 3 after returning to sea level，showing no significant difference from baseline．choroidal vascular volume and choroidal vascularity index decreased significantly from day 2 of exposure（P<0.05），remained at this reduced level on days 4,7，and 10 with no difference from day 2，and returned to baseline levels by day 3 after returning to sea level（P>0.05）．choriocapillaris flow density exhibited a transient significant increase only on day 3 of exposure（P<0.05），with no significant difference at other time points compared to baseline．Mean choroidal thickness showed no significant changes throughout the exposure and post-return periods．Conclusion Short-term high-altitude exposure induces alterations in choroidal blood flow in healthy sea lev- el-residing adults，which are reversible upon descent to sea level．

关键词

高海拔 / 脉络膜 / 脉络膜厚度 / 脉络膜基质体积 / 脉络膜血管体积 / 脉络膜血管指数 / 脉络膜毛细血管血流密度

Key words

high altitude / choroid / choroidal thickness / choroidal stromal volume / choroidal vascular volume / choroidal vascularity index / choriocapillaris flow density

参考文献

[1] GILBERT-KAWAI E, COPPEL J, COURT J, et al. Sub- lingual microcirculatory blood flow and vessel density in Sherpas at high altitude[J]. Journal of applied physiol- ogy, 2017, 122(4):1011-1018.

[2] FISCHER M D, SCHATZ A, SEITZ I P, et al. Reversible increase of central choroidal thickness during high- altitude exposure[J]. Investigative opthalmology ＆ vi- sual science, 2015, 56(8):4499.

[3] 向爱群, 曾芳, 钟兴武. 脉络膜在近视发展中的调控作用及其机制[J]. 眼科学报, 2024, 39(12):657-665.

[4] BARTESELLI G, CHHABLANI J, EL-EMAM S, et al. Choroidal volume variations with age,axial length,and sex in healthy subjects:a three-dimensional analysis[J]. Ophthalmology, 2012, 119(12):2572-2578.

[5] DI PIPPO M, SANTIA C, RULLO D, et al. The choroi- dal vascularity index versus optical coherence tomogra- phy angiography in the evaluation of the choroid with a focus on age-related macular degeneration[J]. Tomogra- phy, 2023, 9(4):1456-1470.

[6] QI Z Y, LIU X X, XIONG S Y, et al. Macular and peri- papillary Choroidal Vascularity Index in children with different refractive status[J]. Eye, 2024, 38(3):606-613.

[7] 漆子飞, 宋晓静, 王晓迪, 等. 高原环境对药物药代动力学的影响:机制、临床意义与展望[J]. 兰州大学学报(医学版), 2026, 52(1):104-110.

[8] REINER A, FITZGERALD M E C, DEL MAR N, et al. Neural control of choroidal blood flow[J]. Progress in retinal and eye research, 2018, 64:96-130.

[9] SPAIDE R F. CHOROIDAL BLOOD FLOW:review and potential explanation for the choroidal venous anat- omy including the Vortex Vein system[J]. Retina, 2020, 40(10):1851-1864.

[10] BOSCH M M, MERZ T M, BARTHELMES D, et al. New insights into ocular blood flow at very high alti- tudes[J]. Journal of applied physiology, 2009, 106(2): 454-460.

[11] RICHALET J P, HERMAND E, LHUISSIER F J. Car- diovascular physiology and pathophysiology at high altitude[J]. Nature reviews cardiology, 2024, 21 (2): 75-88.

[12] 齐平, 蒋贤森, 王晓娟, 等. 高原缺氧和氧化应激:作用机制及治疗新方法[J]. 兰州大学学报(医学版), 2025, 51(11):88-94.

[13] 黄海香, 张文芳, 杨义, 等. 红景天对模拟高海拔缺氧的大鼠视网膜组织形态以及缺氧诱导因子表达的影响[J]. 中华眼底病杂志, 2014, 30(6):599-603.

[14] LIU S Y, DU N, GE K K, et al. NMN supplementation inhibits endothelial cell ROS-mediated src/Pi3k/Akt signaling pathway to protect high-altitude blood-retinal barrier[J]. Investigative ophthalmology ＆ visual sci- ence, 2025, 66(4):51.

[15] 吴芳, 刘凤, 左涵珺, 等. 新生大鼠缺氧后脉络丛中血管紧张素转化酶的表达变化[J]. 神经解剖学杂志, 2020, 36(6):641-646.

[16] HAN C, LI Y T, ZHENG X X, et al. Choroidal thicken- ing and retinal dopamine increase in mice at high alti- tude[J]. Experimental eye research, 2025, 251:110241.

[17] RACIBORSKA A, PIEKLARZ B, GIŃDZIEŃSKA- SIEŚKIEWICZ E, et al. Assessment of interocular sym- metry of choroidal vascularity index and thickness in pa- tients with systemic sclerosis:a prospective study[J]. Frontiers in medicine, 2025, 11:1513679.

[18] SPAIDE R F, FUJIMOTO J G, WAHEED N K. Image artifacts in optical coherence tomography angiogra- phy[J]. Retina, 2015, 35(11):2163-2180.

[19] SOUZA R, BARBOSA F, ARAÚJO G, et al. Ultrathin monolithic zirconia veneers:reality or future?report of a clinical case and one-year follow-up[J]. Operative dentistry, 2018, 43(1):3-11.

[20] DE ASÍS BARTOL-PUYAL F, ISANTA C, CALVO P, et al. Relationship between vascular densities of chorio- capillaris and the whole choroid using OCTA[J]. Inter- national ophthalmology, 2020, 40(11):3135-3143.

基金资助

国家自然科学基金区域科学专项基金资助项目(82360209)