阻塞性睡眠呼吸暂停综合征患者的血管内皮功能及意义

Observation on Change of Vascular Endothelial Function and its Significance

目的 探讨阻塞性睡眠呼吸暂停综合征 (OSAS)患者血管内皮功能变化指标血浆一氧化氮及内皮素与冠心病 (CHD)的内在联系。方法 随机选择 4 3例中、老年健康者为对照组 ,5 9例中、老年中、重度阻塞性睡眠呼吸暂停综合征患者为OSAS组 ,OSAS组又分为有CHD (2 1例 )和无CHD (38例 )两组 ,测定和比较组间的血浆一氧化氮(NO)、内皮素 (ET)及其比值的动态变化及OSAS组内CHD有无的区别。结果 对照组和OSAS组受检者的血浆NO、ET、NO/ET间差别均有非常显著性意义 (P <0 0 1)。CHD的发生率在OSAS组达 35 6 %。OSAS患者中伴CHD与不伴CHD的患者血浆NO、ET、NO/ET均值间的差别有显著性意义 (P <0 0 5 ) ;不伴CHD、伴CHD的患者血浆NO、ET和NO/ET的均值与对照组相比差别均有显著性意义 (P <0 0 5 )。结论 中、老年OSAS患者存在明显的血管内皮功能障碍 ,尤以CHD者为甚 ,血管内皮功能损伤可能是OSAS患者并发CHD的原因之一。

Objective To investigate the association of functional change index of vescular endothelium,plasma levels of nitricoxide (NO) and endothelin with coronary heart disease (CHD) in patients with obstructive sleep apnea syndrome (OSAS).Methods 43 healthy middle-aged and elderly people were randomly selected as control group.59 middle-aged or elderly patients with moderate or severe degree of OSAS were recruited as OSAS group,which were further divided into two subgroups,CHD subgroup(21 patients)and non-CHD subgroup ( 38 patients ).The changes of plasma concentrations of NO and ET were tested and compared between groups.Results Compared with control group,in OSAS group there was a significant lower NO level(58.47±13.04 μmol/L vs 31.68±7.74 μmol/L,P<0.01),higher ET level(31.68±12.74 ng/L vs 50.21±14.02 ng/L,P<0.05),and lower rate of NO/ET(1.67±0.62 vs 0.59±0.34,P<0.01).The incidence of CHD in OSAS group was 35.6%.Comparison between two subgroups in OSAS patients,it was showed that wwer further decreased NO level,increased ET level and declined NO/ET in non-CHD group (all P<0.05).Compared with control group,decreased NO level,elevated ET level and decreased NO/ET was significant in non-CHD OSAS subgroup(all P<0.05),and more significant in CHD OSAS subgroup (all P< 0.01).Conclusion Vascular endothelial function was significantly impaired in patients with OSAS,especially in those with both OSAS and CHD.Vascular endothelial dysfunction may be one of the causes of complicated CHD in OSAS patients.