阻塞性睡眠呼吸暂停对血压、内皮功能及左室质量的影响

The Impact of Obstructive Sleep Apnea on Blood Pressure, Endothelial Function and Left Ventricular Mass

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)对动态血压、血管内皮功能、肾素血管紧张素醛固酮系统(RAAS)及左室质量的影响。方法将130例有或无OSAS的高血压患者和血压正常者分为4组:对照组(NS组)、单纯高血压组(EH组)、单纯OSAS组及OSAS高血压组(OSAS+EH组),进行了动态血压、超声心动图、血一氧化氮(NO)、内皮素(ET)、肾素(PRA)、血管紧张素Ⅱ(AngⅡ)和醛固酮(Ald)测定。结果(1)不论有无高血压的OSAS患者,夜间血压下降率<10%,比无OSAS组较多见(P<0.001);且OSAS+EH组血压较EH组高(P<0.05～0.001)。(2)OSAS+EH组和OSAS组ET(83.0±5.8,44.0±5.0)ng/L升高,与NS组比较差异有显著性(P<0.001)。而OSAS+EH组与OSAS组NO(31.1±4.4,45.7±4.4)μmol/L下降,与NS组比较差异有显著性(P<0.001)。(3)血PRA、AngⅡ、Ald含量在OSAS+EH组及OSAS组升高,与NS组比较差异有显著性(P<0.001)。(4)OSAS+EH组、OSAS组左室质量指数(LVMI)(159.8±8.4,135.3±6.0)g/m2与NS组(121.2±6.5)g/m2比较,差异有显著性(P<0.001),且OSAS+EH组与EH组(134.9±5.7)g/m2比较,差异有显著性(P<0.001)。结论OSAS患者血压昼夜节律消失,且伴有血管内皮功能紊乱、RAAS激活,由此进一步加重对心脏等靶器官的损害。

Objective To explore the impact of obstructive sleep apnea syndrome （OSAS）on ambulary blood pressure, endothelial function, renin （PRA） angiotension （Ang） aldosterone （Aid） system （RAAS） and left ventrieular mass. Methods The ambulary blood pressure, eehoeardiogram, serum nitric oxide（ NO）, plasma concentrations of endothelin（ ET）, PRA, AT, Aid were determined. Based on patients with or without OSAS, subjects were subdivided as ： normal subjects （ n = 30 ）, hypertension alone（ n =35）, OSAS alone（n=30）, and OSAS associated with hypertension（n=35） Results In patients of OSAS BP nocturnal fall was less than that of non-OSAS. Plasma ET levels were higer in patients of OSAS± EH and OSAS group than NS group（ 83. 0 ± 5.8 and 44. 0 ± 5.0 vs 34. 7 ± 3.6 ng/L, P〈0. 001）, while the serum NO levels were lower（31.1±4.4 and 45.7±4.4 vs 67.8±7.6 μmol/L, P〈0.001）. Plasma PRA, Ang Ⅱ , Aid were significantly higher in patients of OSAS±EH and OSAS groups（P〈0. 001 ）. LVMI were increased in patients of OSAS± EH group and OSAS group compared with NS group （159.8± 8.4 and 135.3±6.0 vs 121.2±6.5）g/m^2, P〈0.001）. The LVMI difference between OSAS±EH group and EH group （134. 9±5.7）g/m^2 were also statistically significant（P〈0. 001 ）. Conclusion The prevalence of non-dipper pattern of BP, endothelia dysfunction as well as the activation of RAAS in patients in OSAS may contribute to the accentuated damage of target organs.