高原地区急性心肌梗死的研究进展

Research Progress on Acute Myocardial Infarction in High-Altitude Area

摘要: 目的：冠状动脉粥样硬化性心脏病的发病率仍呈持续上升趋势，且在全球心血管病死亡率中占比显著。在欧洲，冠心病每年致使约180万人死亡。其中急性心肌梗死(acute myocardial infarction, AMI)是因冠状动脉急性阻塞或狭窄，引发心肌缺血缺氧性坏死。此病常并发致死性的恶性心律失常、心力衰竭及心源性休克等状况，若未能及时救治，死亡率会大幅提升。我国高原面积广袤(海拔3000米以上区域占国土面积1/6)，是全球高原面积最大、高原常住人口最多的国家，长期处于低压低氧环境下，人体为维持组织氧供平衡，会启动一系列代偿性适应反应，如红细胞增多、血液黏稠度增加等。这些改变可能会提升急性心肌梗死的发病概率。同时，高原地区寒冷的气候、当地居民高盐高脂的饮食习惯等，均与急性心肌梗死发生密切相关。因此，急性心肌梗死在高原地区并非罕见疾病。近年来，国内外学者针对平原地区AMI的流行病学特征、发病机制及防治策略已积累了较丰富的证据，然而，针对高原地区急AMI的相关研究比较欠缺。本文围绕高原地区急性心肌梗死的相关内容进行综述，梳理现有证据，以期引起学界和临床界的重视。

Abstract: Objective: The incidence of coronary atherosclerotic heart disease continues to rise, accounting for a significant proportion of global cardiovascular mortality. In Europe, coronary heart disease causes approximately 1.8 million deaths annually. Among these, acute myocardial infarction (AMI) results from acute obstruction or narrowing of the coronary arteries, leading to myocardial ischemia and hypoxic necrosis. This condition frequently complicates with life-threatening malignant arrhythmias, heart failure, and cardiogenic shock. Without timely intervention, mortality rates increase substantially. China possesses vast high-altitude area (areas above 3000 meters account for one-sixth of its land area), making it the country with the largest highland area and the most permanent highland residents globally. Prolonged exposure to low-pressure, low-oxygen environments triggers compensatory adaptive responses in the human body to maintain tissue oxygen balance, such as increased red blood cell count and elevated blood viscosity. These changes may increase the likelihood of acute myocardial infarction. Concurrently, the cold climate of plateau regions and local residents’ high-salt, high-fat dietary habits are closely associated with AMI occurrence. Thus, AMI is not a rare disease in high-altitude area. In recent years, scholars worldwide have accumulated substantial evidence on the epidemiological characteristics, pathogenesis, and prevention strategies for AMI in lowland regions. However, research on acute AMI in high-altitude area remains relatively scarce. This review examines the relevant aspects of acute myocardial infarction in high-altitude area, synthesizing existing evidence to draw attention from both academic and clinical communities.