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北京大学学报（医学版） ›› 2026, Vol. 58 ›› Issue (1): 196-200. doi: 10.19723/j.issn.1671-167X.2026.01.026

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血红蛋白影响血氧饱和度的性别特异性阈值: 基于藏族住院患者的非线性回归分析

贡觉卓玛1,*, 毛奕汀1,*, 达娃普珍1, 拉巴次仁1, 闫琦1,2,*()   

  1. 1. 西藏自治区人民医院手术麻醉科, 拉萨 850002
    2. 北京大学人民医院麻醉科, 北京 100044
  • 收稿日期:2025-08-12 出版日期:2026-02-18 发布日期:2026-01-05
  • 通讯作者: 闫琦
  • 作者简介:

    * Theses authors contributed equally to this work

  • 基金资助:
    北京大学人民医院研究与发展基金(RDJP2022-68); 北京大学人民医院研究与发展基金(RDE2022-21); 北京市住院医师规范化培训质量提高项目(2023011); 西藏自治区自然科学基金组团式医疗援藏项目(XZ2024ZR-ZY013(Z))

Sex-specific hemoglobin thresholds for oxygen saturation: A non-linear regression analysis based on Tibetan inpatients

Zhuoma GONGJUE1, Yiting MAO1, Puzhen DAWA1, Ciren LABA1, Qi YAN1,2,*()   

  1. 1. Department of Anesthesiology, People's Hospital of Xizang Autonomous Region, Lhasa 850002, China
    2. Department of Anesthesiology, Peking University People's Hospital, Beijing 100044, China
  • Received:2025-08-12 Online:2026-02-18 Published:2026-01-05
  • Contact: Qi YAN
  • Supported by:
    Peking University People's Hospital Research and Development Funds(RDJP2022-68); Peking University People's Hospital Research and Development Funds(RDE2022-21); Beijing Resident Standardized Training Quality Improvement Project(2023011); Xizang Autonomous Region Natural Science Foundation Group Medical Aid Project(XZ2024ZR-ZY013(Z))

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摘要：

目的: 探究高原低氧环境下外科住院患者血红蛋白水平与静息脉搏氧饱和度(pulse oxygen saturation, SpO2)的关联性, 划定性别特异性的血红蛋白生理适应阈值, 为高原健康管理提供依据。方法: 本研究为横断面研究, 纳入2023年1月至2024年10月西藏自治区人民医院(海拔3 650 m)住院的成年患者, 通过多因素线性回归分析血红蛋白与静息SpO2的关联, 并采用限制性立方样条和似然比检验探索非线性阈值效应。模型校正年龄、体重指数、高血压病史、糖尿病病史、吸烟史、饮酒史及合并肺部疾病等混杂因素。结果: 共纳入住院患者3 083例, 包括男性1 450例, 女性1 633例。限制性立方样条分析结果表明, 血红蛋白与SpO2存在阈值效应(非线性检验P=0.006)。分段线性多因素回归确定了女性住院患者血红蛋白阈值为15.482 g/dL, 高于该值时SpO2随血红蛋白升高显著下降(β=-0.477, 95%CI: -0.760~-0.193, P=0.001);男性住院患者血红蛋白阈值为17.288 g/dL, 高于该值时SpO2随血红蛋白升高显著下降(β=-0.344, 95%CI: -0.550~-0.138, P=0.001)。结论: 高原住院患者血红蛋白水平与氧合状态的性别特异性阈值分别为: 女性15.482 g/dL, 男性17.288 g/dL, 超过阈值时血红蛋白升高和SpO2下降存在关联, 提示高原健康管理中需按性别分层监测血红蛋白。

关键词: 血氧饱和度, 血红蛋白, 高海拔, 阈值效应, 健康管理

Abstract:

Objective: To investigate the complex association between hemoglobin levels and resting pulse oxygen saturation (SpO2) among surgical inpatients in a high-altitude environment, and to define precise, gender-specific physiological adaptation thresholds for hemoglobin, thereby providing evidence-based reference values for health management strategies in high-altitude populations. Methods: This cross-sectional study enrolled adult inpatients from People's Hospital of Xizang Autonomous Region (altitude: 3 650 m) between January 2023 and October 2024. To rigorously evaluate the relationship between hemoglobin and resting SpO2, multivariate linear regression analysis was performed. Furthermore, restricted cubic spline models and likelihood ratio tests were utilized to explore potential non-linear threshold effects. Models were adjusted for potential confounding factors, including age, body mass index, hypertension, diabetes, smoking, alcoholism, and comorbid pulmonary diseases. Results: A total of 3 083 inpatients were enrolled in the final analysis, comprising 1 450 males and 1 633 females. The restricted cubic spline analysis revealed a significant non-linear relationship between hemoglobin levels and SpO2 for the total population (non-linear test, P=0.006), indicating a distinct turning point in the dose-response curve. Two-piecewise linear regression models subsequently identified distinct inflection points for each sex. For female inpatients, the hemoglobin threshold was determined to be 15.482 g/dL; Above this level, SpO2 significantly decreased as hemoglobin increased (β=-0.477, 95%CI: -0.760 to -0.193, P=0.001). Similarly, for male inpatients, the threshold was identified at 17.288 g/dL; Exceeding this value resulted in a significant inverse correlation between hemoglobin and SpO2 (β=-0.344, 95%CI: -0.550 to -0.138, P=0.001). Conclusion: This study establishes specific hemoglobin thresholds for oxygenation status in hospitalized patients at high altitude: 15.482 g/dL for females and 17.288 g/dL for males. Beyond these cut-off values, further increases in hemoglobin are associated with a deterioration in SpO2, suggesting a transition from physiological adaptation to maladaptive hemoconcentration. These findings highlight the necessity of sex-stratified hemoglobin monitoring and potential preoperative optimization in high-altitude health management to prevent hypoxia-related complications.

Key words: Oxygen saturation, Hemoglobin, Altitude, Threshold effect, Health management

中图分类号: 

  • R339.54

表1

藏族住院患者基线特征"

Variables Total (n=3 083) Male (n=1 450) Female (n=1 633) P
Age/years, $\bar x \pm s$ 45.0±14.6 47.3±14.1 43.0±14.7 < 0.001
BMI/(kg/m2), $\bar x \pm s$ 23.8±4.2 23.5±4.0 24.1±4.4 < 0.001
Hypertension, n(%) 275 (8.9) 107 (7.4) 168 (10.3) 0.005
Diabetes, n(%) 46 (1.5) 26 (1.8) 20 (1.2) 0.194
Smoking history, n(%) 441 (14.3) 419 (28.9) 22 (1.3) < 0.001
Alcoholism, n(%) 503 (16.3) 408 (28.1) 95 (5.8) < 0.001
Comorbid pulmonary disease, n(%) 1 505 (48.8) 729 (50.3) 776 (47.5) 0.127
Hemoglobin/(g/dL), $\bar x \pm s$ 15.5±2.5 16.8±2.1 14.4±2.2 < 0.001
SpO2 at rest/%, M (P25, P75) 90.0 (88.0, 91.0) 90.0 (88.0, 91.0) 90.0 (88.0, 91.0) 0.121
SpO2 at rest<88%, n(%) 615 (19.9) 268 (18.5) 347 (21.2) 0.055

表2

藏族住院患者血红蛋白与静息脉搏氧饱和度关联性的多因素线性回归分析(按性别分层)"

Items Crude coefficient (95%CI) Crude P value Adjusted coefficient (95%CI) Adjusted P value
Female -0.141 (-0.211 to -0.066) < 0.001 -0.081 (-0.149 to 0.004) 0.038
Male -0.184 (-0.255 to -0.113) < 0.001 -0.124(-0.202 to -0.047) 0.002

图1

藏族女性(A)和男性(B)住院患者血红蛋白与静息SpO2的非线性关联"

表3

藏族住院患者血红蛋白对静息脉搏氧饱和度影响的阈值效应分析"

Gender Hemoglobin n Coefficient (95%CI) P value
Female < 15.482 g/dL 1 164 -0.021 (-0.121, 0.080) 0.688
≥15.482 g/dL 469 -0.477 (-0.760, -0.193) 0.001
Likelihood ratio test < 0.001
Male < 17.288 g/dL 904 0.032 (-0.099, 0.163) 0.634
≥17.288 g/dL 546 -0.344 (-0.550, -0.138) 0.001
Likelihood ratio test < 0.001
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ISSN 1671-167X
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