阻塞性睡眠呼吸暂停低通气综合征患者血浆心钠素、脑钠素的变化

Variation of plasma atrium natriuretic peptide and brain natriuretic peptide in patients with obstructive sleep apnea-hypopnea syndrome

目的观察单纯阻塞性睡眠呼吸暂停低通气综合征(OSAHS)和OSAHS合并高血压患者的血浆心钠素(ANP)、脑钠素(BNP)水平的变化及其与OSAHS的关系。方法受试对象共47例,平均年龄(44.2±15.3)岁,均给予整夜多导睡眠监测(PSG)。受试者分为3组:单纯OSAHS组(17例),OSAHS合并高血压组(15例),正常对照组(15例)。血浆ANP、BNP采用放射免疫法测定。结果(1)OSAHS合并高血压组血浆ANP、BNP水平较单纯OSAHS组明显增高(P<0.05),单纯OSAHS组又较正常对照组显著增高(P<0.01)。(2)血浆ANP水平与收缩压(SBP)、平均动脉压(MAP)及脉搏氧饱和度SpO2<0.9时间呈显著正相关(P<0.01),与最低SpO2、平均SpO2呈负相关(P<0.05)。(3)血浆BNP水平与平均SpO2呈负相关(P<0.05),与SBP、DBP、MAP及SpO2<0.9时间呈正相关(P<0.01)。结论(1)ANP、BNP在OS-AHS的发病机制中可能起着重要作用。(2)缺氧是导致OSAHS患者清晨血浆ANP增高的主要因素。(3)血压升高是导致OSAHS患者清晨血浆BNP增高的主要因素。

Objective To investigate the significance of the changes of plasma atrium natriuretic peptide and brain natriuretie peptide levels in patients with obstructive sleep apnea-hypopnea syndrome （OSAHS）. Methods There were 47 subjects, including 38 men and 9 women, with mean age of （44.2＋ 15.3） ）,ears. All of them un- derwent whole night polysomnography（PSG）. Plasma atrium natriuretie peptide and brain natriuretie peptide levels were determined by radioimmunoassay. Results The concentration of plasma ANP and BNP in cases of OSAHS with hypertension were higher than those without hypertension significantly（ P 〈 0.05）, the concentration of plasma ANP and BNP in eases of OSAHS without hypertension were higher than controls（ P 〈 0.01 ）. The plasma ANP lev- el was positively correlated with SBP, MAP and SpO2 〈 0.9 time（ P 〈 0.01 ）, and it was negatively correlated with the lowest SpO2 and average SpO2 （ P 〈 0.05）. The plasma BNP level was positively correlated with SBP, DBP, MAP and SpO2 〈 0.9%time （ P 〈 0.01）,and it was negatively correlated with average SpO2 （P 〈 0.05）. Conelusion ANP and BNP are involved in the pathophysiological process of OSAHS and may play a compensatory role in it. It is suggested that hypoxia may be the predominant factor affecting the plasma ANP level. Hypertension may be the main agent affecting the increasing plasma BNP level of OSAHS patients in the morning.