Wang, Chi, Hui Jiang, Jinyan Duan, Jingwen Chen, Qi Wang, Xiaoting Liu, and Chengbin Wang. Exploration of acute phase proteins and inflammatory cytokines in early stage diagnosis of acute mountain sickness. High Alt Med Biol. 19:170-177, 2018.
Background: Early diagnosis of acute mountain sickness (AMS) is currently based on personal appreciation of the severity of symptoms. A more objective method to diagnose AMS is required. Inflammatory cytokines and acute phase proteins have been reported to be different at high altitude.
Methods: A total of 104 male soldiers rapidly ascending from Beijing (20-60 m) to Germu, Qinghai (3200 m), were divided into AMS group and non-AMS group according to the Lake Louis Score system. Blood pressure, pulse rate, and oxygen saturation were measured. Forty-nine blood samples were collected before and on the 3rd day after ascending to the high altitude. Serum haptoglobin (Hp), transferrin (Tf), and complement C3 were detected by immune scattered nephelometry, whereas serum interleukin-1beta (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α) were detected by chemical luminescence immunity analyzer. The sensitivity, specificity, and receiver operating characteristic curve were evaluated. Youden index with the maximum value was used to determine cutoff values of each parameter. Logistic regression was performed to determine the diagnostic efficiency of combination of three cytokines.
Results: Differences of physical indexes between AMS group and non-AMS group were of no statistical significance. In AMS group, serum Tf significantly increased while Hp decreased when compared with non-AMS group. Serum IL-1β, IL-6, and TNF-α were higher in the AMS group than in the non-AMS group. The cutoff values for Tf, Hp, IL-1β, IL-6, and TNF-α were 263.5 mg/dL, 119.35 mg/dL, 6.2 pg/mL, 15.05 pg/mL, and 18.35 pg/mL, respectively. Area under the curve (AUC) of combining three cytokines together was higher than AUC of each cytokine separately.
Conclusions: Acute phase proteins and inflammatory cytokines (IL-1β, IL-6, and TNF-α) show significant changes between the AMS group and the non-AMS group. Combination of inflammatory cytokines or acute phase proteins improves the specificity for diagnosis of AMS. This might provide objective indexes for scanning and screening individuals susceptible to AMS in the early stage of rapid ascending.
Keywords: acute mountain sickness; acute phase protein; diagnosis; inflammatory cytokine.