IJPNInternational Journal of Psychiatry and Neurology2166-5788Scientific Research Publishing10.12677/IJPN.2022.112003IJPN-51894IJPN20220200000_16092644.pdf医药卫生 银杏叶提取物对急性高原反应的预防效果比较研究 A Comparative Study on Preventive Effect of Ginkgo biloba Extract on Acute Altitude Sickness 杨俊21武晨21王艳21任军21范晓敏21新疆军区总医院神经内科，新疆 乌鲁木齐null3005202211021418© Copyright 2014 by authors and Scientific Research Publishing Inc. 2014This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/

目的：比较银杏叶提取物与不同预防高原反应药物对急进高原人群高原反应的预防效果及区别，筛选出更有效的预防高原反应的药物。方法：选取急进高原人群300人，随机分为三组：银杏叶提取物组(n = 100)、红景天组(n = 100)和丹参滴丸组(n = 100)，分别于急进高原前3天按说明服用上述三种药品，记录脉搏、血压、心率、SaO2等指标，采用急性高原反应评定量表评价急进高原前后2周内的高原反应情况。结果：与丹参滴丸比较，银杏叶提取物及红景天对急进高原人群疲乏无力、头痛、头晕、睡眠障碍、嗜睡、倦怠、血压升高、血氧饱和度降低等有明显效果，存在显著差异(P < 0.05)。与红景天比较，银杏叶提取物对急进高原人群上述指标有降低的趋势，但无明显统计学意义(P > 0.05)；银杏叶提取物组与红景天组比较在第6天时出现头痛的比例有显著降低(8.9% vs 19.8%，P < 0.05)。结论：银杏叶提取物及红景天对急进高原人群疲乏无力、头痛、头晕、睡眠障碍、嗜睡、倦怠、血压升高、血氧饱和度降低等有明显效果，银杏叶提取物对预防急进高原人群头痛的发生较红景天有效，银杏叶提取物与红景天在预防急进高原反应中的优劣尚待进一步研究。 Objective: To compare the preventive effects and differences between Ginkgo biloba extract and dif-ferent drugs for the prevention of altitude sickness in people rushing into the plateau, and screen out more effective drugs for the prevention of altitude sickness. Methods: Three hundred people were randomly divided into three groups: Ginkgo biloba extract group (n = 100), Rhodiola group (n = 100) and Danshen dripping pill group (n = 100). The above three drugs were taken according to the instructions three days before entering the plateau. The indexes of pulse, blood pressure, heart rate and SaO2 were recorded. The incidence of altitude sickness was evaluated by the acute high al-titude sickness rating scale within 2 weeks after entering the high altitude. Results: Compared with Danshen dripping pill, Ginkgo biloba extract and Rhodiola had significant effects on fatigue, head-ache, dizziness, sleep disorder, drowsiness, burnout, increased blood pressure and decreased blood oxygen saturation of people who entered the plateau rapidly (P < 0.05); compared with Rhodiola, Ginkgo biloba extract had a tendency to reduce the above indexes of people who entered the plateau rapidly, but there was no statistical significance (P > 0.05). The proportion of headache in Ginkgo biloba extract group was significantly lower than that in Rhodiola group on the 6th day (8.9% vs 19.8%, P < 0.05). Conclusion: Ginkgo biloba extract and Rhodiola have obvious effects on fatigue, headache, dizziness, sleep disorders, drowsiness, burnout, increased blood pressure, decreased blood oxygen saturation, etc. Ginkgo biloba extract is more effective than Rhodiola in preventing headaches in people who rush to the plateau. The advantages and disadvantages of Ginkgo biloba extract and Rhodiola in the prevention of acute altitude sickness need to be further studied.

急性高原反应，银杏叶提取物，红景天，丹参滴丸, Acute Mountain Sickness Ginkgo biloba Extract Rhodiola Danshen Dripping Pill摘要

目的：比较银杏叶提取物与不同预防高原反应药物对急进高原人群高原反应的预防效果及区别，筛选出更有效的预防高原反应的药物。方法：选取急进高原人群300人，随机分为三组：银杏叶提取物组(n = 100)、红景天组(n = 100)和丹参滴丸组(n = 100)，分别于急进高原前3天按说明服用上述三种药品，记录脉搏、血压、心率、SaO2等指标，采用急性高原反应评定量表评价急进高原前后2周内的高原反应情况。结果：与丹参滴丸比较，银杏叶提取物及红景天对急进高原人群疲乏无力、头痛、头晕、睡眠障碍、嗜睡、倦怠、血压升高、血氧饱和度降低等有明显效果，存在显著差异(P < 0.05)。与红景天比较，银杏叶提取物对急进高原人群上述指标有降低的趋势，但无明显统计学意义(P > 0.05)；银杏叶提取物组与红景天组比较在第6天时出现头痛的比例有显著降低(8.9% vs 19.8%，P < 0.05)。结论：银杏叶提取物及红景天对急进高原人群疲乏无力、头痛、头晕、睡眠障碍、嗜睡、倦怠、血压升高、血氧饱和度降低等有明显效果，银杏叶提取物对预防急进高原人群头痛的发生较红景天有效，银杏叶提取物与红景天在预防急进高原反应中的优劣尚待进一步研究。

关键词

急性高原反应，银杏叶提取物，红景天，丹参滴丸

A Comparative Study on Preventive Effect of Ginkgo biloba Extract on Acute Altitude Sickness<sup> </sup>

Jun Yang*, Chen Wu, Yan Wang, Jun Ren, Xiaomin Fan

Department of Neurology, Xinjiang Urumqi Military General Hospital, Urumqi Xinjiang

Received: Apr. 23rd, 2022; accepted: May 23rd, 2022; published: May 31st, 2022

ABSTRACT

Objective: To compare the preventive effects and differences between Ginkgo biloba extract and different drugs for the prevention of altitude sickness in people rushing into the plateau, and screen out more effective drugs for the prevention of altitude sickness. Methods: Three hundred people were randomly divided into three groups: Ginkgo biloba extract group (n = 100), Rhodiola group (n = 100) and Danshen dripping pill group (n = 100). The above three drugs were taken according to the instructions three days before entering the plateau. The indexes of pulse, blood pressure, heart rate and SaO2 were recorded. The incidence of altitude sickness was evaluated by the acute high altitude sickness rating scale within 2 weeks after entering the high altitude. Results: Compared with Danshen dripping pill, Ginkgo biloba extract and Rhodiola had significant effects on fatigue, headache, dizziness, sleep disorder, drowsiness, burnout, increased blood pressure and decreased blood oxygen saturation of people who entered the plateau rapidly (P < 0.05); compared with Rhodiola, Ginkgo biloba extract had a tendency to reduce the above indexes of people who entered the plateau rapidly, but there was no statistical significance (P > 0.05). The proportion of headache in Ginkgo biloba extract group was significantly lower than that in Rhodiola group on the 6th day (8.9% vs 19.8%, P < 0.05). Conclusion: Ginkgo biloba extract and Rhodiola have obvious effects on fatigue, headache, dizziness, sleep disorders, drowsiness, burnout, increased blood pressure, decreased blood oxygen saturation, etc. Ginkgo biloba extract is more effective than Rhodiola in preventing headaches in people who rush to the plateau. The advantages and disadvantages of Ginkgo biloba extract and Rhodiola in the prevention of acute altitude sickness need to be further studied.

Keywords:Acute Mountain Sickness, Ginkgo biloba Extract, Rhodiola, Danshen Dripping Pill

Copyright © 2022 by author(s) and Hans Publishers Inc.

This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).

http://creativecommons.org/licenses/by/4.0/

1. 引言

急性高原反应(Acute Mountain Sickness, AMS)是指发生在海拔2500 m以上的一种高原特发病，最常见的临床表现是头痛、心悸、头晕、疲劳和失眠。国内调查数据显示，在海拔2840 m，3572 m，4236 m和5108 m时急性高原反应总发生率分别为3.8%，19.2%，38.1%和76.5% [1]。国外调查显示，进入2500 m高度AMS的发病率在10%~25%，攀登5895 m的乞力马扎罗山时，急性高原反应发病率在50%~75% [2] [3]。AMS严重影响初入高原者的身体健康和急进高原者的工作质量，甚至危及生命。目前我国每年进出高原者已达到数百万之众，因此，筛选更有效预防AMS的药物，具有重要现实意义。

2. 对象与方法2.1. 研究对象

纳入标准：既往体健，无基础疾病，年龄18~40岁，体重指数(BMI) < 25 kg/m2，同意参与本次实验研究，并签署同意书的青年男性；排除标准：年龄小于18岁或大于40岁，既往有高血压、肺部疾病、心脏疾病等基础疾病，体重指数(BMI) ≥ 25 kg/m2，不同意参与此次研究，拒签知情同意书的。共300名符合上述要求的急进高原(海拔4300 m)人群，随机分为银杏叶提取物组(n = 100，于进入高原前3天服用银杏叶提取物片2片，3/日，口服15天)、丹参滴丸组(n = 100，于进入高原前3天服用丹参滴丸10丸，3/日，口服15天)、红景天组(n = 100，于进入高原前3天服用高原红景天，2片，3/日，口服15天)。

2.2. 方法

通过高原反应评估量表，比较各组头痛、胃肠道症状、疲劳/无力、头晕/头重脚轻、入睡困难、精神状态改变、周围性水肿、共济失调等高原反应症状；监测脉搏、血压、心率、SaO2等生命体征及参数，从进入高原前三天开始，共监测15天。

2.3. 统计学分析

正态分布计量资料以均数 ± 标准差( x ¯ ± s )表示，非正态分布计量资料以中位数表示，采用SPSS10.0统计软件，组间比较采用t检验、计数资料采用X2检验，P < 0.05为有显著差异。

3. 结果3.1. 入组患者的一般资料

共纳入急进高原人群患者300例，银杏叶提取物组、丹参滴丸组、红景天组各100例，均为男性，年龄18~31岁，各组中位年龄分别为23岁、22岁、23岁，各组之间无明显差异；各组所处的海拔高度均在4300 m以上，急进高原的速度为3~4天，到达4300 m的时间为两天，各组无明显差异，各组内均无高血压、心脏病、肺部疾病等基础疾病。

3.2. 各组之间进入高原后高原反应症状的发生率

各组进入高原后第3天高原反应的发生率达到高峰，后逐步降低。表1所示：与丹参滴丸组比较，银杏叶组、红景天组疲乏无力、头痛、头晕、入睡困难、精神状态改变等症状的发生率明显较低，差别有统计学意义(P < 0.05)，总的高原反应症状发生率分别为：丹参滴丸组82%、红景天组42%、银杏叶组31%，差别有统计学意义(P < 0.05)。而与红景天组比较，银杏叶提取物对急进高原人群上述指标有降低的趋势，但无明显统计学意义(P > 0.05)。银杏叶组与红景天组比较在第6天时出现头痛的比例有显著差异(8.6% vs 19.8%，P < 0.01)。

The incidence of different symptoms of acute altitude sickness on the 3rd day after entering the plateau between group
丹参滴丸组(%)红景天组(%)银杏叶组(%)
疲乏无力
轻度7653*34*
中重度620
头痛
轻度8835*47*
中重度2150
头晕
轻度8444*36*
中重度490
入睡困难
轻度6436*29*
中重度3291
精神状态改变3624*16*
总的高原反应8242*31*

表1. 各组之间进入高原后第3天急性高原反应不同症状的发生率

注：*与丹参滴丸组比较P < 0.05。

3.3. 各组之间进入高原后生命体征的变化

表2所示：各组进入高原后均有血压增高、脉搏增快、血氧饱和度下降等表现，在进入高原后第6天生命体征逐渐适应高原环境，趋于平稳。与丹参滴丸组比较，银杏叶组、红景天组血压、心率的增幅均有降低的趋势，而血氧饱和度的降幅有明显的改善，差别有统计学意义(P < 0.05)。

Changes of vital signs on the 6th day after entering the plateau between group
丹参滴丸组红景天组银杏叶组
脉搏101次/分90次/分93次/分
血压收缩压134 mmHg121 mmHg123 mmHg
舒张压85 mmHg76 mmHg74 mmHg
血氧饱和度60%84%*84%*

表2. 各组之间进入高原后第6天生命体征变化

注：*与丹参滴丸组比较P < 0.05。

4. 讨论

当人体暴露在高海拔后1~5天内(≥2500米)，因对低压缺氧环境的适应能力不足，会引起组织缺氧，进而发生急性高原病(Acute Mountain Sickness, AMS)、高原肺水肿(High Altitude Pulmonary Edema, HAPE)、高原脑水肿(High Altitude Brain Edema, HACE)等一系列高原疾病 [4]。牛文忠等通过对文献资料和临床病例统计分析，虽然近年来在AMS预防研究上取得较大成绩，但是预防药物研究进步缓慢 [5]。目前的预防高原反应药物探索和研究提出的药物虽多，但是评价的指标和方法缺乏规范性和科学性，未对其不良反应和适应人群进行深入的研究。因而尚无明确切实有效、安全可靠的预防AMS药物。

红景天胶囊、丹参滴丸是广泛使用的预防高原反应药物，但有研究表明，其预防高原反应的作用与安慰剂对比无明显差别 [6]。自1996年发表的银杏叶提取物(Ginkgo biloba extract, GBE)预防AMS的试验以来，其对预防AMS的疗效尚不清楚 [7]。近年来的荟萃分析显示：目前的数据表明，虽然GBE可能有预防AMS的作用，但没有足够的数据显示GBE在预防AMS方面具有统计学意义。进一步的大规模随机对照研究是必要的 [8]。

本研究比较了银杏叶提取物片、丹参滴丸、及红景天胶囊对急进高原人群急性高原反应的预防作用，研究表明：银杏叶提取物及红景天对疲乏无力、头痛、头晕、睡眠障碍、嗜睡、倦怠、血压升高、血氧饱和度降低等有明显效果，存在显著差异(P < 0.05)；银杏叶组与红景天组比较在第6天时出现头痛的比例有显著差异(P < 0.05)，说明银杏叶提取物对预防急进高原人群头痛的发生有效。

通过本研究表明银杏叶提取物和红景天是有效的预防AMS的药物，可显著降低AMS症状发生的比例，其中银杏叶提取物具有更好的抗高原反应的效果，其机制可能与银杏叶提取物的多重作用机制有关。现有研究表明：银杏提取物在治疗阿尔茨海默病、脑外伤、心血管和缺血性脑血管疾病、正常衰老、水肿、耳鸣和黄斑变性等神经系统后遗症方面显示出良好的前景。作用机制可能包括抗氧化、神经递质/受体调节和抗血小板活化因子特性 [9] [10]，银杏叶提取物促进神经突起生长，激活PI3K/Akt/mTOR通路，提示银杏叶提取物影响神经可塑性 [11]。而这些机制与AMS及HACE的病理生理机制具有重叠性 [12]。

本研究由于纳入的样本量较少，各组之间急进高原的最终海拔高度分布差异较大(4300~5300 m)，各组达到最高海拔点的时间宽度不同，可能影响发生实验结果的客观性和准确性，需要更大样本量及更严格流程管控下的进一步实验研究。

5. 总结

综上所述，银杏叶提取物片及红景天片对预防急进高原人群的AMS症状有显著作用，进一步研究其机制并推广使用对减少急进高原人群的AMS、加快高原习服过程、近而减少AMS的发生有一定效果。

基金项目

陆军后勤面上项目(CLJ6J004)。

文章引用

杨 俊,武 晨,王 艳,任 军,范晓敏. 银杏叶提取物对急性高原反应的预防效果比较研究 A Comparative Study on Preventive Effect of Ginkgo biloba Extract on Acute Altitude Sickness[J]. 国际神经精神科学杂志, 2022, 11(02): 14-18. https://doi.org/10.12677/IJPN.2022.112003

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